NPIMap

Organization Active NPI

SG Dental Associates of Maryland LLC

  • General Practice Dentistry
  • Hagerstown, MD
National Provider Identifier
1508254145
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15671 Issued in MD
Legal business name
SG DENTAL ASSOCIATES OF MARYLAND LLC
Practice address
1730 Massey Blvd
Ste 106
Hagerstown, MD 21740-6973
Phone
(301) 800-7041
Fax
(240) 420-5497
NPI assigned
Jan 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Authorized official

Name
Kim Van Camp
Title
Provider Relations Specialist
Phone
(315) 464-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 15671 MD Primary

Addresses

Primary practice location

1730 Massey Blvd
Ste 106
Hagerstown, MD 21740-6973

Mailing address

1730 Massey Blvd
Ste 106
Hagerstown, MD 21740-6973
Phone (301) 800-7041

Other names 1

  • Aspen Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1730 Massey Blvd
Ste 106
Hagerstown, MD 21740
Phone (240) 347-0918

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1508254145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 MASSEY BLVD",
            "address_2": "STE 106",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406973",
            "telephone_number": "301-800-7041",
            "fax_number": "240-420-5497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 MASSEY BLVD",
            "address_2": "STE 106",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406973",
            "telephone_number": "301-800-7041",
            "fax_number": "240-420-5497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SG DENTAL ASSOCIATES OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-06",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "VAN CAMP",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "315-464-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "15671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; 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.