Provider Demographics
NPI:1851968549
Name:GLEN BURNIE ORAL SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:GLEN BURNIE ORAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-701-3581
Mailing Address - Street 1:2508 STONE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3733
Mailing Address - Country:US
Mailing Address - Phone:917-701-3581
Mailing Address - Fax:
Practice Address - Street 1:677 E PULASKI HWY STE D
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6037
Practice Address - Country:US
Practice Address - Phone:917-701-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty