Provider Demographics
NPI:1891172581
Name:ANDREW BOOKWALTER DDS LLC
Entity type:Organization
Organization Name:ANDREW BOOKWALTER DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOOKWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-641-4710
Mailing Address - Street 1:314 FRANKLIN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1263
Mailing Address - Country:US
Mailing Address - Phone:410-641-4710
Mailing Address - Fax:410-641-4720
Practice Address - Street 1:314 FRANKLIN AVE STE 401
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1263
Practice Address - Country:US
Practice Address - Phone:410-641-4710
Practice Address - Fax:410-641-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery