Provider Demographics
NPI:1083006951
Name:ODENTON STATION DENTAL
Entity Type:Organization
Organization Name:ODENTON STATION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-874-2222
Mailing Address - Street 1:1110 TOWN CENTER BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1232
Mailing Address - Country:US
Mailing Address - Phone:410-874-2222
Mailing Address - Fax:443-856-2745
Practice Address - Street 1:1110 TOWN CENTER BLVD STE H
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1232
Practice Address - Country:US
Practice Address - Phone:410-874-2222
Practice Address - Fax:443-856-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty