Provider Demographics
NPI:1356300974
Name:ALLEGANY DENTAL CARE PA
Entity Type:Organization
Organization Name:ALLEGANY DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:301-797-8987
Mailing Address - Street 1:19418 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1438
Mailing Address - Country:US
Mailing Address - Phone:301-797-8987
Mailing Address - Fax:301-797-6351
Practice Address - Street 1:19418 LEITERSBURG PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1438
Practice Address - Country:US
Practice Address - Phone:301-797-8987
Practice Address - Fax:301-797-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty