Provider Demographics
NPI:1992117683
Name:ANNAPOLIS GREEN DENTAL
Entity type:Organization
Organization Name:ANNAPOLIS GREEN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-257-7200
Mailing Address - Street 1:2331 FOREST DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3868
Mailing Address - Country:US
Mailing Address - Phone:410-224-4500
Mailing Address - Fax:
Practice Address - Street 1:2331 FOREST DR
Practice Address - Street 2:SUITE E
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3868
Practice Address - Country:US
Practice Address - Phone:410-224-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty