Provider Demographics
NPI:1073160305
Name:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:CHOPTANK COMMUNITY HEALTH SYSTEM INC
Other - Org Name:DENTON DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4306
Mailing Address - Street 1:808 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1398
Mailing Address - Country:US
Mailing Address - Phone:410-479-2650
Mailing Address - Fax:833-916-1012
Practice Address - Street 1:808 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1398
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:833-916-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)