Provider Demographics
NPI:1659703353
Name:WOODSBORO DENTAL
Entity Type:Organization
Organization Name:WOODSBORO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE RAJASKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-756-8875
Mailing Address - Street 1:309 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WOODSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21798-8511
Mailing Address - Country:US
Mailing Address - Phone:301-898-7151
Mailing Address - Fax:
Practice Address - Street 1:309 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WOODSBORO
Practice Address - State:MD
Practice Address - Zip Code:21798-8511
Practice Address - Country:US
Practice Address - Phone:301-898-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL ENHANCEMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty