Provider Demographics
NPI:1700270527
Name:GOLDEN DRAGONFLY ACUPUNCTURE & ORIENTAL MEDICINE
Entity type:Organization
Organization Name:GOLDEN DRAGONFLY ACUPUNCTURE & ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:GRANVILLE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-448-4833
Mailing Address - Street 1:221 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1036
Mailing Address - Country:US
Mailing Address - Phone:443-448-4833
Mailing Address - Fax:443-448-4834
Practice Address - Street 1:221 MARKET ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1036
Practice Address - Country:US
Practice Address - Phone:443-448-4833
Practice Address - Fax:443-448-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02099171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty