Provider Demographics
NPI:1003274382
Name:BRIAN K MOTZ DDS PC
Entity Type:Organization
Organization Name:BRIAN K MOTZ DDS PC
Other - Org Name:MONOCACY VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-698-0044
Mailing Address - Street 1:65B THOMAS JOHNSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-698-0044
Mailing Address - Fax:301-698-1440
Practice Address - Street 1:65B THOMAS JOHNSON DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-698-0044
Practice Address - Fax:301-698-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty