Provider Demographics
NPI:1235358417
Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Other - Org Name:CAMBRIDGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4306
Mailing Address - Street 1:503 MUIR ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1848
Mailing Address - Country:US
Mailing Address - Phone:410-228-9381
Mailing Address - Fax:410-228-9384
Practice Address - Street 1:503 MUIR ST STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1848
Practice Address - Country:US
Practice Address - Phone:410-228-9381
Practice Address - Fax:410-228-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)