Provider Demographics
NPI:1275611469
Name:CHESAPEAKE ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:CHESAPEAKE ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ZABIEGALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-862-5600
Mailing Address - Street 1:46940 SOUTH SHANGRI LA DRIVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653
Mailing Address - Country:US
Mailing Address - Phone:301-862-5600
Mailing Address - Fax:301-862-3332
Practice Address - Street 1:46940 SOUTH SHANGRI LA DRIVE
Practice Address - Street 2:SUITE 17
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653
Practice Address - Country:US
Practice Address - Phone:301-862-5600
Practice Address - Fax:301-862-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty