Provider Demographics
NPI:1194846295
Name:PENN DENTAL INC.
Entity Type:Organization
Organization Name:PENN DENTAL INC.
Other - Org Name:HOWARD PARK DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DYSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-542-7877
Mailing Address - Street 1:4901 LIBERTY HEIGHTS AVE
Mailing Address - Street 2:1721 PENNSYLVANIA AVENUE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7052
Mailing Address - Country:US
Mailing Address - Phone:410-542-7877
Mailing Address - Fax:410-542-7884
Practice Address - Street 1:4901 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7052
Practice Address - Country:US
Practice Address - Phone:410-542-7877
Practice Address - Fax:410-542-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD85971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherD.D.S.