Provider Demographics
NPI:1619943099
Name:CHARLAND BASSFORD, ALICE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MARIE
Last Name:CHARLAND BASSFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:MARIE
Other - Last Name:CHARLAND STUTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:10301 GEORGIA AVE
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-593-5500
Mailing Address - Fax:301-593-3771
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:SUITE # 207
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-593-5500
Practice Address - Fax:301-593-3771
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6238050001Medicare NSC