Provider Demographics
NPI:1841039070
Name:MARYLAND DENTAL HEALTHCARE NETWORK, LLC
Entity type:Organization
Organization Name:MARYLAND DENTAL HEALTHCARE NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-498-2177
Mailing Address - Street 1:572 RITCHIE HWY STE F
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2966
Mailing Address - Country:US
Mailing Address - Phone:410-647-4094
Mailing Address - Fax:
Practice Address - Street 1:101 RIDGELY AVE STE 12B
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1415
Practice Address - Country:US
Practice Address - Phone:410-267-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty