Provider Demographics
NPI:1407020084
Name:WOODDELL & PASSARO DENTAL GROUP LLC
Entity Type:Organization
Organization Name:WOODDELL & PASSARO DENTAL GROUP LLC
Other - Org Name:DAVIDSONVILLE DENTISTRY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-956-5555
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035
Mailing Address - Country:US
Mailing Address - Phone:410-956-5555
Mailing Address - Fax:410-798-5165
Practice Address - Street 1:3102 DAVIDSONVILLE ROAD
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035
Practice Address - Country:US
Practice Address - Phone:410-956-5555
Practice Address - Fax:410-798-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD75921223G0001X
MD76461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty