| Maryland Oral Surgery Associates, Llc | |
|
14955 Shady Grove Road Suite 330 Rockville MD 20850-8700 | |
| (301) 340-0101 | |
| (301) 340-1689 |
| Full Name | Maryland Oral Surgery Associates, Llc |
|---|---|
| Speciality | Dentist |
| Location | 14955 Shady Grove Road, Rockville, Maryland |
| Authorized Official Name and Position | Glenn A Nathan (PRESIDENT) |
| Authorized Official Contact | 3013406884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryland Oral Surgery Associates, Llc 14955 Shady Grove Road Suite 350 Rockville MD 20850-8700 Ph: (301) 340-6884 | Maryland Oral Surgery Associates, Llc 14955 Shady Grove Road Suite 330 Rockville MD 20850-8700 Ph: (301) 340-0101 |
| NPI Number | 1326159179 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/08/2023 |
| Medicare PECOS PAC ID | 5092794354 |
|---|---|
| Medicare Enrollment ID | O20040719001404 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326159179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Glenn A Nathan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1336220128 PECOS PAC ID: 7315926672 Enrollment ID: I20040720000504 |
| Provider Name | Miari Ann H Griffith |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891876694 PECOS PAC ID: 1153337407 Enrollment ID: I20060224000047 |
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