Provider Demographics
NPI:1255497160
Name:EGERT RILEY DEROO AND ASSOCIATES PA
Entity Type:Organization
Organization Name:EGERT RILEY DEROO AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:EGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-719-7900
Mailing Address - Street 1:4 EAST ROLLING CROSSROADS
Mailing Address - Street 2:STE 205
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-719-7900
Mailing Address - Fax:410-719-7816
Practice Address - Street 1:4 EAST ROLLING CROSSROADS
Practice Address - Street 2:STE 205
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-719-7900
Practice Address - Fax:410-719-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty