Provider Demographics
NPI:1366988719
Name:BALTIMORE CITY DENTAL GROUP
Entity type:Organization
Organization Name:BALTIMORE CITY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-353-2820
Mailing Address - Street 1:300 N CHARLES ST
Mailing Address - Street 2:STE D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4305
Mailing Address - Country:US
Mailing Address - Phone:410-685-0002
Mailing Address - Fax:410-244-5001
Practice Address - Street 1:300 N CHARLES ST
Practice Address - Street 2:STE D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4305
Practice Address - Country:US
Practice Address - Phone:410-685-0002
Practice Address - Fax:410-244-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty