Provider Demographics
NPI:1538185442
Name:KODECK, ROBERT LEONARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEONARD
Last Name:KODECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 ROSSVILLE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-882-9330
Mailing Address - Fax:
Practice Address - Street 1:7850 ROSSVILLE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-882-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD56541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice