Provider Demographics
NPI:1336647551
Name:DUSTIN SENTZ LLC
Entity Type:Organization
Organization Name:DUSTIN SENTZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:FORRESTER
Authorized Official - Last Name:SENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:410-370-0299
Mailing Address - Street 1:1107 KENILWORTH DR STE 208
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2136
Mailing Address - Country:US
Mailing Address - Phone:410-370-0299
Mailing Address - Fax:
Practice Address - Street 1:1107 KENILWORTH DR STE 208
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-370-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty