Provider Demographics
NPI:1043779085
Name:ST. MARY'S CENTER FOR DENTAL SLEEP MEDICINE LLC
Entity Type:Organization
Organization Name:ST. MARY'S CENTER FOR DENTAL SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-884-3248
Mailing Address - Street 1:28160 OLD VILLAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659
Mailing Address - Country:US
Mailing Address - Phone:301-884-3248
Mailing Address - Fax:886-219-6469
Practice Address - Street 1:28160 OLD VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659
Practice Address - Country:US
Practice Address - Phone:301-884-3248
Practice Address - Fax:886-219-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty