Provider Demographics
NPI:1992129928
Name:BURTONSVILLE DENTAL GROUP LLC
Entity type:Organization
Organization Name:BURTONSVILLE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-421-1996
Mailing Address - Street 1:3905 NATIONAL DR
Mailing Address - Street 2:#260
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1100
Mailing Address - Country:US
Mailing Address - Phone:301-421-1996
Mailing Address - Fax:
Practice Address - Street 1:3905 NATIONAL DR
Practice Address - Street 2:#260
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1100
Practice Address - Country:US
Practice Address - Phone:301-421-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty