Provider Demographics
NPI:1386858991
Name:GARY R. IMM DDS PA DBA ALL SMILES DENTAL CARE
Entity Type:Organization
Organization Name:GARY R. IMM DDS PA DBA ALL SMILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:IMM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-848-9070
Mailing Address - Street 1:1758 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7109
Mailing Address - Country:US
Mailing Address - Phone:410-848-9070
Mailing Address - Fax:410-848-7485
Practice Address - Street 1:1758 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7109
Practice Address - Country:US
Practice Address - Phone:410-848-9070
Practice Address - Fax:410-848-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD079241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty