Northwest Dental Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

7474 Issued in MD

Legal business name

NORTHWEST DENTAL INC

Practice address

4821 Butler Road
Suite 2B
Glyndon, MD 21071

Phone

(410) 486-5580

Fax

(410) 484-6365

NPI assigned

Feb 17, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Phillip B Surosky, D.D.S.

Title

Dentist

Phone

(410) 486-5580

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234828800000",
    "number": "1194964015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4821 BUTLER ROAD",
            "address_2": "SUITE 2B",
            "city": "GLYNDON",
            "state": "MD",
            "postal_code": "21071",
            "telephone_number": "410-486-5580",
            "fax_number": "410-484-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4821 BUTLER ROAD",
            "address_2": "SUITE 2B",
            "city": "GLYNDON",
            "state": "MD",
            "postal_code": "21071",
            "telephone_number": "410-486-5580",
            "fax_number": "410-484-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-17",
        "last_updated": "2009-02-17",
        "status": "A",
        "authorized_official_last_name": "SUROSKY",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "410-486-5580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MD",
            "license": "7474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah K Romay DDS PA LLC
• Therese Lynch
• Mark J Nesbitt DDS LLC
• MTC Anesthesia Associates
• Ashley Nicole N Neal Sullivan, LCSW
• Michael Joseph Provencher Jr., LGPC
• Leah Kaitlyn Romay, DDS
• Phillip Barry Surosky, D.D.S.
• Jay Christian Toth, DDS
• Amonda Bentley Wroe, N.P.

• Dental Clinic/Center in Glyndon, MD
• Providers in Glyndon, MD by specialty
• Dental Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; 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.