Provider Demographics
NPI:1588356562
Name:HAGERSTOWN DENTIST LLC
Entity type:Organization
Organization Name:HAGERSTOWN DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SHARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-401-6336
Mailing Address - Street 1:1303 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3107
Mailing Address - Country:US
Mailing Address - Phone:301-200-9585
Mailing Address - Fax:301-200-9585
Practice Address - Street 1:1303 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3107
Practice Address - Country:US
Practice Address - Phone:301-200-9585
Practice Address - Fax:301-200-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental