Provider Demographics
NPI:1225694029
Name:SOUTHERN MARYLAND FAMILY DENTAL
Entity Type:Organization
Organization Name:SOUTHERN MARYLAND FAMILY DENTAL
Other - Org Name:SOUTHERN MARYLAND FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-848-5321
Mailing Address - Street 1:1438 DEFENSE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-2023
Mailing Address - Country:US
Mailing Address - Phone:410-721-3567
Mailing Address - Fax:
Practice Address - Street 1:1438 DEFENSE HWY STE 101
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-2023
Practice Address - Country:US
Practice Address - Phone:410-721-3567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty