Provider Demographics
NPI: | 1356466536 |
---|---|
Name: | DENTAL ONE ASSOCIATES COLUMBIA PC |
Entity Type: | Organization |
Organization Name: | DENTAL ONE ASSOCIATES COLUMBIA PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | INSURANCE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MIKE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 727-726-1611 |
Mailing Address - Street 1: | 10630 LITTLE PATUXENT PKWY |
Mailing Address - Street 2: | 410 |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21044-3264 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10630 LITTLE PATUXENT PKWY |
Practice Address - Street 2: | 410 |
Practice Address - City: | COLUMBIA |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21044-3264 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-884-3666 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-20 |
Last Update Date: | 2010-07-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 6384150001 | Medicare NSC |