Provider Demographics
NPI:1013345511
Name:THE ORAL SURGERY CENTER AT MITCHELLVILLE
Entity Type:Organization
Organization Name:THE ORAL SURGERY CENTER AT MITCHELLVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIARI-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-627-1105
Mailing Address - Street 1:12164 CENTRAL AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1903
Mailing Address - Country:US
Mailing Address - Phone:301-627-1105
Mailing Address - Fax:301-627-1105
Practice Address - Street 1:12164 CENTRAL AVE STE 224
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1903
Practice Address - Country:US
Practice Address - Phone:301-627-1105
Practice Address - Fax:301-627-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty