Provider Demographics
NPI:1306990411
Name:DUANE A. ANGLIN AND KIMANI BETHEA-ANGLIN, D.D.S., P.A.
Entity type:Organization
Organization Name:DUANE A. ANGLIN AND KIMANI BETHEA-ANGLIN, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:ALDOUS
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-654-4544
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-337-7004
Mailing Address - Fax:410-337-7644
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-337-7004
Practice Address - Fax:410-337-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129081223G0001X
MD131651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty