Provider Demographics
NPI:1245742741
Name:AKESO ORAFACIAL MAXILLARY SURGERY
Entity Type:Organization
Organization Name:AKESO ORAFACIAL MAXILLARY SURGERY
Other - Org Name:LAUREL ORAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-665-2500
Mailing Address - Street 1:7544 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4108
Mailing Address - Country:US
Mailing Address - Phone:410-665-2500
Mailing Address - Fax:410-665-3235
Practice Address - Street 1:7544 BELAIR ROAD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-665-2500
Practice Address - Fax:410-665-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19522Medicaid