Provider Demographics
NPI:1083014591
Name:IB DENTAL I, P.C.
Entity Type:Organization
Organization Name:IB DENTAL I, P.C.
Other - Org Name:IBRUSH FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-254-5437
Mailing Address - Street 1:6105 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1312
Mailing Address - Country:US
Mailing Address - Phone:410-254-5437
Mailing Address - Fax:410-254-5310
Practice Address - Street 1:6105 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1312
Practice Address - Country:US
Practice Address - Phone:410-254-5437
Practice Address - Fax:410-254-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141391223G0001X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty