Provider Demographics
NPI:1073978847
Name:DIPAULA DENTISTRY
Entity Type:Organization
Organization Name:DIPAULA DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:DIPAULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-668-6540
Mailing Address - Street 1:8509 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4619
Mailing Address - Country:US
Mailing Address - Phone:410-668-6540
Mailing Address - Fax:
Practice Address - Street 1:8509 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-4619
Practice Address - Country:US
Practice Address - Phone:410-668-6540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty