Provider Demographics
NPI:1225686157
Name:BRENTWOOD PEDIATRIC DENTISTRY MARYLAND FARMS, PLLC
Entity Type:Organization
Organization Name:BRENTWOOD PEDIATRIC DENTISTRY MARYLAND FARMS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CREGGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:615-377-3080
Mailing Address - Street 1:95 SEABOARD LN STE 102
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3037
Mailing Address - Country:US
Mailing Address - Phone:615-377-3080
Mailing Address - Fax:
Practice Address - Street 1:5109 PETER TAYLOR PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7672
Practice Address - Country:US
Practice Address - Phone:615-373-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty