Provider Demographics
NPI:1164130027
Name:MARYLAND HOLISTIC DENTISTRY
Entity Type:Organization
Organization Name:MARYLAND HOLISTIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:FRIES
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-905-8738
Mailing Address - Street 1:1017 GENERALS HWY
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1017 GENERALS HWY
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-1421
Practice Address - Country:US
Practice Address - Phone:410-923-2586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental