Provider Demographics
NPI:1689247587
Name:AKESO CHESAPEAKE ORAL SURGERY LLC
Entity Type:Organization
Organization Name:AKESO CHESAPEAKE ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:443-289-1684
Mailing Address - Street 1:6798 OAK HALL LN STE A1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2360 W JOPPA RD STE 310
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4639
Practice Address - Country:US
Practice Address - Phone:410-670-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty