Provider Demographics
NPI:1679762652
Name:CUMBERLAND ORAL & MAXILLOFACIAL SURGERY LLC
Entity type:Organization
Organization Name:CUMBERLAND ORAL & MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-722-3205
Mailing Address - Street 1:1715 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1037
Mailing Address - Country:US
Mailing Address - Phone:301-722-3205
Mailing Address - Fax:
Practice Address - Street 1:1715 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1037
Practice Address - Country:US
Practice Address - Phone:301-722-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty