Provider Demographics
NPI:1518298462
Name:CENTRAL MARYLAND ORAL AND MAXILLOFACIAL SURGERY, P. A.
Entity Type:Organization
Organization Name:CENTRAL MARYLAND ORAL AND MAXILLOFACIAL SURGERY, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NESSIF
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:410-997-1010
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-997-1010
Mailing Address - Fax:410-997-0807
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-997-1010
Practice Address - Fax:410-997-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty