Provider Demographics
NPI:1457007155
Name:BURTONSVILLE DENTAL SUITE, LLC
Entity Type:Organization
Organization Name:BURTONSVILLE DENTAL SUITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-421-1300
Mailing Address - Street 1:3905 NATIONAL DR STE 340
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6111
Mailing Address - Country:US
Mailing Address - Phone:301-421-1300
Mailing Address - Fax:
Practice Address - Street 1:3905 NATIONAL DR STE 340
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6111
Practice Address - Country:US
Practice Address - Phone:301-421-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty