Provider Demographics
NPI:1114084514
Name:LAUREL PINES DENTAL GROUP, CHARTERED
Entity Type:Organization
Organization Name:LAUREL PINES DENTAL GROUP, CHARTERED
Other - Org Name:LAUREL PINES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:A'BECKET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-953-3081
Mailing Address - Street 1:14333 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1126
Mailing Address - Country:US
Mailing Address - Phone:301-953-3081
Mailing Address - Fax:301-725-4885
Practice Address - Street 1:14333 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1126
Practice Address - Country:US
Practice Address - Phone:301-953-3081
Practice Address - Fax:301-725-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental