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

Last updated

Feb 17, 2009By the provider in NPPES

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.NPI 1851422893

Title

Dentist

Phone

(410) 486-5580

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phillip Barry Surosky, D.D.S.

  • Dentist
  • Glyndon, MD
  • NPI 1851422893
  Authorized official Same address or phone

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": []
}

• Therese Lynch
• Patrick Michael Mahon, ACNPC-AG, PMHNP-BC
• 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
• Veritas Psychiatry & Wellness, LLC

• 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.