Professional Dental Alliance of Maryland, LLC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF MARYLAND, LLC

Practice address

1415 River Ave Ste B
Cumberland, MD 21502-4629

Phone

(240) 362-7017

NPI assigned

Sep 24, 2020

Last updated

Sep 24, 2020By 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

Lauren Howard

Title

Credentialing Specialist

Phone

(757) 576-5479

Specialties & licenses 2

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.

• Marc Fisher, D.D.S.

  • Periodontics
  • Silver Spring, MD
  • NPI 1861541484
  NPD (past)

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1720695703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 RIVER AVE STE B",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215024629",
            "telephone_number": "240-362-7017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 Omega Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217405784",
            "country_code": "US",
            "telephone_number": "301-733-6077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "85 Thomas Johnson Ct Ste A",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024331",
            "country_code": "US",
            "telephone_number": "301-663-0052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16069 Comprint Cir",
            "address_purpose": "LOCATION",
            "city": "Gaithersburg",
            "state": "MD",
            "postal_code": "208771321",
            "country_code": "US",
            "telephone_number": "301-527-8480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13975 Connecticut Ave Ste 309",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209062921",
            "country_code": "US",
            "telephone_number": "301-871-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-576-5479"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Printy, LCSW-C
• Privia Medical Group, LLC
• Privia Medical Group, LLC
• Proactive Pain and Neurology, LLC
• Proactive Pain and Neurology, LLC (Proactive Primary Care)
• Professional Dental Alliance of Meridian, PLLC
• Joan Proietti, LCSW-C
• Diana Dawn Pryor, DNP
• Terri L Pryor, PA
• Brian J Przybylowski, PA

• Endodontics in Cumberland, MD
• Providers in Cumberland, MD by specialty
• Endodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.