| Drkbchasellc | |
|
23808 Hollywood Rd Leonardtown MD 20650-5825 | |
| (301) 475-5926 | |
| (301) 475-2653 |
| Full Name | Drkbchasellc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 23808 Hollywood Rd, Leonardtown, Maryland |
| Authorized Official Name and Position | Kenneth Bernard Chase (OWNER) |
| Authorized Official Contact | 3014755926 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Drkbchasellc 23808 Hollywood Rd Leonardtown MD 20650-5825 Ph: (301) 475-5926 | Drkbchasellc 23808 Hollywood Rd Leonardtown MD 20650-5825 Ph: (301) 475-5926 |
| NPI Number | 1912221649 |
|---|---|
| Provider Enumeration Date | 03/24/2010 |
| Last Update Date | 03/24/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912221649 | NPI | - | NPPES |
| 122300000X | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6787 (Maryland) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 14062 (Maryland) | Secondary |
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