| Kids Dental Space, Llc | |
|
7402 York Rd Ste 204 Towson MD 21204-7520 | |
| (301) 537-5536 | |
| Not Available |
| Full Name | Kids Dental Space, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7402 York Rd Ste 204, Towson, Maryland |
| Authorized Official Name and Position | Roxanne Patreace Clarke (PEDIATRIC DENTIST/OWNER) |
| Authorized Official Contact | 3015375536 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Dental Space, Llc 8617 Goldenwood Rd Rosedale MD 21237-2032 Ph: (301) 537-5536 | Kids Dental Space, Llc 7402 York Rd Ste 204 Towson MD 21204-7520 Ph: (301) 537-5536 |
| NPI Number | 1932840220 |
|---|---|
| Provider Enumeration Date | 04/02/2022 |
| Last Update Date | 04/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932840220 | NPI | - | NPPES |
| 046568200 | Medicaid | MD | |
| 1326279829 | Other | MD | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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