Provider Demographics
NPI:1588796353
Name:MUGFORD, DAVID A (DMD PA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MUGFORD
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 VILLAGE GRN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2033
Mailing Address - Country:US
Mailing Address - Phone:410-721-7801
Mailing Address - Fax:410-721-7802
Practice Address - Street 1:1660 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2033
Practice Address - Country:US
Practice Address - Phone:410-721-7801
Practice Address - Fax:410-721-7802
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20-8586462OtherFEDERAL ID