| Laurel Lakes Pediatric Dentistry | |
|
13964 Baltimore Ave Suite C6 Laurel MD 20707 | |
| (202) 276-0649 | |
| (631) 857-7860 |
| Full Name | Laurel Lakes Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 13964 Baltimore Ave, Laurel, Maryland |
| Authorized Official Name and Position | Antionette C. Wilson (OWNER) |
| Authorized Official Contact | 2022760649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurel Lakes Pediatric Dentistry 401 Church St Suite 2210 Nashville TN 37219-2310 Ph: (615) 988-2627 | Laurel Lakes Pediatric Dentistry 13964 Baltimore Ave Suite C6 Laurel MD 20707 Ph: (202) 276-0649 |
| NPI Number | 1649717638 |
|---|---|
| Provider Enumeration Date | 01/27/2017 |
| Last Update Date | 07/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649717638 | NPI | - | NPPES |
| 13970 | Other | MD | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 13970 (Maryland) | Primary |
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