Provider Demographics
NPI:1720725351
Name:MARYLAND DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MARYLAND DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:R PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-798-4027
Mailing Address - Street 1:3450 OLD WASHINGTON RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3251
Mailing Address - Country:US
Mailing Address - Phone:301-645-6611
Mailing Address - Fax:
Practice Address - Street 1:3450 OLD WASHINGTON RD STE 301
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3251
Practice Address - Country:US
Practice Address - Phone:301-645-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND DENTAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-16
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty