Organization
POTOMAC ORAL AND MAXILLOFACIAL SURGERY; LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENDELL GARDNER DDS (ORAL AND MAXILLOFACIAL SURGEON)
(615) 585-9364
Entity
Organization
Contact information
Practice address
3150 W WARD RD STE 306, DUNKIRK, MD 20754-3057
(615) 585-9364
(410) 257-2842
Mailing address
3150 W WARD RD STE 306, DUNKIRK, MD 20754-3057
(410) 257-5333
(410) 257-2842
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679626881
—
TN
05
—
1942407812
—
PA
Enumeration date
03/01/2023
Last updated
03/01/2023
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