Provider Demographics
NPI:1306321856
Name:DENTAL PROFESSIONALS OF MARYLAND, CHARLES FOER, PC
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF MARYLAND, CHARLES FOER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8513
Mailing Address - Street 1:1189 E PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6307
Mailing Address - Country:US
Mailing Address - Phone:443-406-2450
Mailing Address - Fax:
Practice Address - Street 1:1189 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6307
Practice Address - Country:US
Practice Address - Phone:443-406-2950
Practice Address - Fax:443-207-5553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF MARYLAND, CHARLES FOER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-01
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty