Provider Demographics
NPI:1275069510
Name:BALTIMORE WASHINGTON ENDODONTICS
Entity Type:Organization
Organization Name:BALTIMORE WASHINGTON ENDODONTICS
Other - Org Name:BALTIMORE WASHINGTON ENDODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-203-1800
Mailing Address - Street 1:6021 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6077
Mailing Address - Country:US
Mailing Address - Phone:410-203-1800
Mailing Address - Fax:410-203-1974
Practice Address - Street 1:6021 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6077
Practice Address - Country:US
Practice Address - Phone:410-203-1800
Practice Address - Fax:410-203-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty