Provider Demographics
NPI:1093576027
Name:EASTERN SHORE PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:EASTERN SHORE PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ASERMELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-202-8515
Mailing Address - Street 1:917 SNOW HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2408
Mailing Address - Country:US
Mailing Address - Phone:410-202-8515
Mailing Address - Fax:
Practice Address - Street 1:917 SNOW HILL RD STE D
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2408
Practice Address - Country:US
Practice Address - Phone:410-202-8515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty