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572 Ritchie Hwy Ste F Severna Park MD 21146-2966 | |
| (410) 647-4094 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 572 Ritchie Hwy Ste F, Severna Park, Maryland |
| Authorized Official Name and Position | Yeremi Antonio Canizales (OWNER) |
| Authorized Official Contact | 4106474094 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
572 Ritchie Hwy Ste F Severna Park MD 21146-2966 Ph: (410) 647-4094 | 572 Ritchie Hwy Ste F Severna Park MD 21146-2966 Ph: (410) 647-4094 |
| NPI Number | 1275902298 |
|---|---|
| Provider Enumeration Date | 09/21/2015 |
| Last Update Date | 08/09/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275902298 | NPI | - | NPPES |
| 1790079697 | Other | MD | NPI |
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