Provider Demographics
NPI:1093848319
Name:HAROLD PACKMAN, DMD, PA
Entity Type:Organization
Organization Name:HAROLD PACKMAN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-262-2800
Mailing Address - Street 1:14999 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1074
Mailing Address - Country:US
Mailing Address - Phone:301-262-2800
Mailing Address - Fax:301-262-6411
Practice Address - Street 1:14999 HEALTH CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1074
Practice Address - Country:US
Practice Address - Phone:301-262-2800
Practice Address - Fax:301-262-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD51631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty