Provider Demographics
NPI:1386779239
Name:DELICATE DENTAL OF MARYLAND, P.C.
Entity type:Organization
Organization Name:DELICATE DENTAL OF MARYLAND, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-721-8777
Mailing Address - Street 1:1071 MD RT 3 N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1784
Mailing Address - Country:US
Mailing Address - Phone:410-721-8777
Mailing Address - Fax:410-721-5153
Practice Address - Street 1:1071 MD RT 3 N
Practice Address - Street 2:SUITE 201
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1784
Practice Address - Country:US
Practice Address - Phone:410-721-8777
Practice Address - Fax:410-721-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 11133261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD819282OtherUNITED CONCORDIA INSURANC
MDD960OtherBCBS OF MD INSURANCE