| Spectrum Dental Services P A | |
|
200 East 33rd Street Suite 284 Baltimore MD 21218 | |
| (410) 235-0062 | |
| Not Available |
| Full Name | Spectrum Dental Services P A |
|---|---|
| Speciality | Dentist |
| Location | 200 East 33rd Street, Baltimore, Maryland |
| Authorized Official Name and Position | Sheila R Turner Johnson (BUSINESS MANAGER) |
| Authorized Official Contact | 4105414432 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Dental Services P A 200 E 33rd Street Suite 284 Baltimore MD 21218 Ph: (410) 235-0062 | Spectrum Dental Services P A 200 East 33rd Street Suite 284 Baltimore MD 21218 Ph: (410) 235-0062 |
| NPI Number | 1669687802 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 11/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669687802 | NPI | - | NPPES |
| 0004418 | Other | MD | DORAL DENTAL |
| 2009 | Other | MD | CAREFIRST BLUECROSS |
| 000952871 | Other | MD | UNITED CONCORDIA |
| 261864800 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223G0001X | Dentist - General Practice | 7695 (Maryland) | Secondary |
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