Provider Demographics
NPI:1992476469
Name:PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:JUAMBELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-257-7676
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-0219
Mailing Address - Country:US
Mailing Address - Phone:410-257-7676
Mailing Address - Fax:410-257-5212
Practice Address - Street 1:10085 DUNKIRK WAY STE 103
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2024
Practice Address - Country:US
Practice Address - Phone:410-257-7676
Practice Address - Fax:410-257-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty