Provider Demographics
NPI:1316241292
Name:CARROLL COUNTY DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:CARROLL COUNTY DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:FESCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-876-6612
Mailing Address - Street 1:603 NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6109
Mailing Address - Country:US
Mailing Address - Phone:410-876-6612
Mailing Address - Fax:
Practice Address - Street 1:603 NURSERY RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6109
Practice Address - Country:US
Practice Address - Phone:410-876-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD53821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty