Provider Demographics
NPI:1447377718
Name:ALAN J. GOODFRIEND, DMD, GLENN C. SCHERMER, DMD, GUIDO COSTA, DMD,P.A.
Entity type:Organization
Organization Name:ALAN J. GOODFRIEND, DMD, GLENN C. SCHERMER, DMD, GUIDO COSTA, DMD,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-868-5500
Mailing Address - Street 1:7905 MALCOLM RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1734
Mailing Address - Country:US
Mailing Address - Phone:301-868-5500
Mailing Address - Fax:301-877-9393
Practice Address - Street 1:7905 MALCOLM RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1734
Practice Address - Country:US
Practice Address - Phone:301-868-5500
Practice Address - Fax:301-877-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD50561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty