Provider Demographics
NPI:1457584005
Name:POTOMAC DENTAL CENTRE P.A.
Entity Type:Organization
Organization Name:POTOMAC DENTAL CENTRE P.A.
Other - Org Name:POTOMAC DENTAL CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:JANNEY
Authorized Official - Last Name:EKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-790-2007
Mailing Address - Street 1:4 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3333
Mailing Address - Country:US
Mailing Address - Phone:301-790-2007
Mailing Address - Fax:301-790-0981
Practice Address - Street 1:4 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3333
Practice Address - Country:US
Practice Address - Phone:301-790-2007
Practice Address - Fax:301-790-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty