Carole S Burgess-Fongsam, DDS
Individual provider Active NPI General Practice Dentistry · Sandy Spring, MD
NPI 1134447717 · NPPES record last updated Mar 14, 2016
Key facts
- NPI
- 1134447717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9667 (MD)
- Practice address
- 17810 Meeting House Rd
Moore BLDG # 205
Sandy Spring, MD 20860-1038 - Phone
- (301) 774-3847
- Fax
- (301) 774-4528
- NPI assigned
- May 6, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160718001792 | MD | Order and Referring Only - Dentist |
3971896671 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9667 | MD | Yes |
Addresses
Primary practice location
17810 Meeting House Rd
Moore BLDG # 205
Sandy Spring, MD 20860-1038
Mailing address
17810 Meeting House Rd
Moore BLDG # 205
Sandy Spring, MD 20860-1038
Phone (301) 774-3847
Other providers in Sandy Spring, MD
- Ask for Help Inc
- Nancy Jo Baglin
- Brooke Grove Foundation, Inc
- Brooke Grove Foundation, Inc.
- Brooke Grove Foundation, Inc.
- Victoria Carter
- Kristen Casella
- Charles & Linda Steel DDS PA
- Whitney Chou
- Ajeet Choxi
All providers in Sandy Spring, MD · General Practice Dentistry in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.