Provider Demographics
NPI:1386891851
Name:DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:410-848-5577
Mailing Address - Street 1:2029 SUFFOLK RD STE A
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-1630
Mailing Address - Country:US
Mailing Address - Phone:410-861-8900
Mailing Address - Fax:410-861-8445
Practice Address - Street 1:2029 SUFFOLK RD STE A
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1630
Practice Address - Country:US
Practice Address - Phone:410-861-8900
Practice Address - Fax:410-861-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD53821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty