Provider Demographics
NPI:1467027987
Name:AKESO OROFACIAL SURGERY MAPLE LAWN
Entity Type:Organization
Organization Name:AKESO OROFACIAL SURGERY MAPLE LAWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:TREVANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-290-7757
Mailing Address - Street 1:6798 OAK HALL LN STE A1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4892
Mailing Address - Country:US
Mailing Address - Phone:410-290-7757
Mailing Address - Fax:
Practice Address - Street 1:7625 MAPLE LAWN BLVD STE 240
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-617-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty