Maryland Oral Surgery Associates, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

11347 Issued in MD

Legal business name

MARYLAND ORAL SURGERY ASSOCIATES, LLC

Practice address

161 Thomas Johnson Dr Ste 295
Frederick, MD 21702-4314

Phone

(301) 698-5208

Fax

(301) 698-1848

NPI assigned

Mar 12, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn A. Nathan, D.D.S.

Title

President

Phone

(301) 340-6884

Specialties & licenses 1

Addresses

Other names 1

• Maryland Oral Surgery Associates of Frederick, LLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1164848370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14955 SHADY GROVE RD.",
            "address_2": "SUITE 350",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20850",
            "telephone_number": "301-340-6884",
            "fax_number": "301-340-3836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 THOMAS JOHNSON DR STE 295",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024314",
            "telephone_number": "301-698-5208",
            "fax_number": "301-698-1848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND ORAL SURGERY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "NATHAN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-340-6884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "11347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maryland Oral Surgery Associates of Frederick, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.