| Marlborough Village Pediatric Dental | |
|
5098 Brown Station Rd Ste 260 Upper Marlboro MD 20772-9124 | |
| (240) 326-3738 | |
| Not Available |
| Full Name | Marlborough Village Pediatric Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5098 Brown Station Rd Ste 260, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Adrian Johnston Wilson (OWNER/DENTIST) |
| Authorized Official Contact | 4432800968 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marlborough Village Pediatric Dental 14300 Ridge View Ln Laurel MD 20707-6278 Ph: (443) 280-0968 | Marlborough Village Pediatric Dental 5098 Brown Station Rd Ste 260 Upper Marlboro MD 20772-9124 Ph: (240) 326-3738 |
| NPI Number | 1710473731 |
|---|---|
| Provider Enumeration Date | 07/02/2018 |
| Last Update Date | 07/02/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710473731 | NPI | - | NPPES |
| 71150100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 14704 (Maryland) | Primary |
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