Provider Demographics
NPI:1427758309
Name:CHITILIAN, JENNIFER MARY (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:CHITILIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E WELLS STREET
Mailing Address - Street 2:APT E5
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230
Mailing Address - Country:US
Mailing Address - Phone:443-833-2088
Mailing Address - Fax:
Practice Address - Street 1:1401 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:443-407-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice