Provider Demographics
NPI:1487061586
Name:DOLFIELD DENTAL, LLC
Entity type:Organization
Organization Name:DOLFIELD DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-902-4110
Mailing Address - Street 1:11155 DOLFIELD BLVD
Mailing Address - Street 2:STE. 204
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3259
Mailing Address - Country:US
Mailing Address - Phone:410-902-4110
Mailing Address - Fax:410-902-4113
Practice Address - Street 1:11155 DOLFIELD BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3259
Practice Address - Country:US
Practice Address - Phone:410-902-4110
Practice Address - Fax:410-902-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty