Provider Demographics
NPI:1760506653
Name:MARK C. HERLSON,D.D.S.,P.A.
Entity Type:Organization
Organization Name:MARK C. HERLSON,D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:HERLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-530-9111
Mailing Address - Street 1:5411 W CEDAR LN STE 208A
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1526
Mailing Address - Country:US
Mailing Address - Phone:301-530-9111
Mailing Address - Fax:301-530-1898
Practice Address - Street 1:5411 W CEDAR LN STE 208A
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1526
Practice Address - Country:US
Practice Address - Phone:301-530-9111
Practice Address - Fax:301-530-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD49461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty