Provider Demographics
NPI:1164297313
Name:DENTAL HEALTH PROFESSIONALS OF MARYLAND, BADGER, P.C.
Entity Type:Organization
Organization Name:DENTAL HEALTH PROFESSIONALS OF MARYLAND, BADGER, P.C.
Other - Org Name:COSMETIC & ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:5 PARK CENTER CT STE 302
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 PARK CENTER CT STE 302
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4203
Practice Address - Country:US
Practice Address - Phone:410-697-6290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH PROFESSIONALS OF MARYLAND, BADGER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty