Provider Demographics
NPI:1760633663
Name:CORNERSTONE ORAL & MAXILLOFACIAL SURGERY, LLC
Entity Type:Organization
Organization Name:CORNERSTONE ORAL & MAXILLOFACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:FORSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:240-529-8863
Mailing Address - Street 1:1130 BALTIMORE BLVD
Mailing Address - Street 2:UNIT C-1
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7098
Mailing Address - Country:US
Mailing Address - Phone:410-982-0650
Mailing Address - Fax:410-982-0655
Practice Address - Street 1:1130 BALTIMORE BLVD
Practice Address - Street 2:UNIT C-1
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7098
Practice Address - Country:US
Practice Address - Phone:410-982-0650
Practice Address - Fax:410-982-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13760261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery