Provider Demographics
NPI:1972838936
Name:DRS LEARY , BURROUGHS AND WOODS, L.L.C.
Entity Type:Organization
Organization Name:DRS LEARY , BURROUGHS AND WOODS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-923-0373
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-0786
Mailing Address - Country:US
Mailing Address - Phone:410-923-0373
Mailing Address - Fax:410-923-1093
Practice Address - Street 1:325 GAMBRILLS RD
Practice Address - Street 2:C
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1102
Practice Address - Country:US
Practice Address - Phone:410-923-0373
Practice Address - Fax:410-923-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty