Organization
POST OFFICE LAKE DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAMEASA LAVONNE JOHNSON (OFFICE CONTACT)
(301) 870-7077
Entity
Organization
Contact information
Practice address
603 POST OFFICE RD STE 208, WALDORF, MD 20602-1914
(301) 870-7077
(301) 843-8030
Mailing address
603 POST OFFICE RD STE 208, WALDORF, MD 20602-1914
(301) 870-7077
(301) 843-8030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10857
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4133552 00
—
MD
05
—
775954160
—
MD
05
—
776024860
—
MD
Enumeration date
06/19/2008
Last updated
06/19/2008
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