Provider Demographics
NPI:1508915802
Name:CHESAPEAKE ENDODONTICS CENTER LLC
Entity Type:Organization
Organization Name:CHESAPEAKE ENDODONTICS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:LUZADER
Authorized Official - Suffix:
Authorized Official - Credentials:ENDODONTIST DDS
Authorized Official - Phone:410-224-7556
Mailing Address - Street 1:888 BESTGATE RD
Mailing Address - Street 2:#213
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-224-7556
Mailing Address - Fax:410-224-4206
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 213
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-7556
Practice Address - Fax:410-224-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty