Provider Demographics
NPI:1619008620
Name:UMOREN DENTAL SERVICES PC
Entity Type:Organization
Organization Name:UMOREN DENTAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MFON
Authorized Official - Middle Name:ETESIN
Authorized Official - Last Name:UMOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-439-5868
Mailing Address - Street 1:7411 RIGGS RD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4246
Mailing Address - Country:US
Mailing Address - Phone:301-439-5868
Mailing Address - Fax:301-439-9528
Practice Address - Street 1:7411 RIGGS RD
Practice Address - Street 2:SUITE 326
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-4246
Practice Address - Country:US
Practice Address - Phone:301-439-5868
Practice Address - Fax:301-439-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty