| Light Street Dental | |
|
600 Light St Baltimore MD 21230-3856 | |
| (410) 659-0900 | |
| (410) 659-0902 |
| Full Name | Light Street Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 600 Light St, Baltimore, Maryland |
| Authorized Official Name and Position | Nicole Celeste Forel (MANAGER) |
| Authorized Official Contact | 4106590901 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Street Dental 10 W Montgomery St Baltimore MD 21230-3806 Ph: (410) 783-1340 | Light Street Dental 600 Light St Baltimore MD 21230-3856 Ph: (410) 659-0900 |
| NPI Number | 1851688816 |
|---|---|
| Provider Enumeration Date | 06/28/2011 |
| Last Update Date | 06/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851688816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 13598 (Maryland) | Primary |
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