Potomac Oral & Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

POTOMAC ORAL & MAXILLOFACIAL SURGERY

Practice address

955 North Prince Frederick Blvd
Suite 104
Prince Frederick, MD 20678-3057

Phone

(410) 535-2416

Fax

(443) 968-8646

NPI assigned

Mar 19, 2024

Organization subpart

Yes

Parent organization

POTOMAC ORAL & MAXILLOFACIAL SURGERYAs reported in NPPES

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

Authorized official

Name

Wendell Gardner, DDS

Title

Owner

Phone

(410) 257-5333

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Potomac Oral Maxillofacial Surgery2 organizations share this tax ID, including this one

Part of

Potomac Oral Maxillofacial Surgery

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Potomac Oral and Maxillofacial Surgery; LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dunkirk, MD
  • NPI 1972202711
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Potomac Oral and Maxillofacial Surgery; LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dunkirk, MD
  • NPI 1972202711
  NPPES parent name

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1821858937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 W WARD RD",
            "address_2": "SUITE 306",
            "city": "DUNKIRK",
            "state": "MD",
            "postal_code": "20754",
            "telephone_number": "410-257-5333",
            "fax_number": "410-257-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 NORTH PRINCE FREDERICK BLVD",
            "address_2": "SUITE 104",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206783057",
            "telephone_number": "410-535-2416",
            "fax_number": "443-968-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POTOMAC ORAL & MAXILLOFACIAL SURGERY",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-257-5333",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215149900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Steel Polak, RN
• Connor Elizabeth Polosky
• Laurence B Polsky, MD
• Paul V Pomilla, MD
• Nancy L Porter, LSWA
• Carolyn B Potts, LCSW
• Stephen William Pournaras III, MD
• Rosana Emmerich Powell
• Karen Ann Prahler, CRNP
• Precision Orthopedics and Sports Medicine

• Oral and Maxillofacial Surgery (Dentist) in Prince Frederick, MD
• Providers in Prince Frederick, MD by specialty
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.