| |
2 E Rolling Crossroads Suite 257 Catonsville MD 21228-6211 | |
(410) 719-0480 | |
(410) 747-3135 |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 2 E Rolling Crossroads, Catonsville, Maryland |
Authorized Official Name and Position | Maxine Villiers Clark (CEO) |
Authorized Official Contact | 4107190480 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2 E Rolling Crossroads Suite 257 Catonsville MD 21228-6211 Ph: (410) 719-0480 | 2 E Rolling Crossroads Suite 257 Catonsville MD 21228-6211 Ph: (410) 719-0480 |
NPI Number | 1992906879 |
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Provider Enumeration Date | 05/30/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992906879 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 8300 (Maryland) | Primary |
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