Provider Demographics
NPI:1265441489
Name:OLDE MILL DENTAL INC
Entity Type:Organization
Organization Name:OLDE MILL DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-982-9522
Mailing Address - Street 1:495 OLD MILL RD
Mailing Address - Street 2:STE C
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21100-1044
Mailing Address - Country:US
Mailing Address - Phone:410-982-9522
Mailing Address - Fax:410-987-1767
Practice Address - Street 1:495 OLD MILL RD
Practice Address - Street 2:STE C
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21100-1044
Practice Address - Country:US
Practice Address - Phone:410-982-9522
Practice Address - Fax:410-987-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD75721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty