Provider Demographics
NPI:1215359625
Name:CHEERFUL DENTAL PC
Entity Type:Organization
Organization Name:CHEERFUL DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-574-2454
Mailing Address - Street 1:301 EASTERN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6940
Mailing Address - Country:US
Mailing Address - Phone:410-574-2454
Mailing Address - Fax:
Practice Address - Street 1:301 EASTERN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-6940
Practice Address - Country:US
Practice Address - Phone:410-574-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty