Provider Demographics
NPI:1427169085
Name:PEDIATRIC DENTISTRY AND ORTHODONTICS OF MARYLAND LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY AND ORTHODONTICS OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-726-1611
Mailing Address - Street 1:7671 QUARTERFIELD RD
Mailing Address - Street 2:#400
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4998
Mailing Address - Country:US
Mailing Address - Phone:410-760-1212
Mailing Address - Fax:410-760-1999
Practice Address - Street 1:7671 QUARTERFIELD RD
Practice Address - Street 2:#400
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4998
Practice Address - Country:US
Practice Address - Phone:410-760-1212
Practice Address - Fax:410-760-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty