Provider Demographics
NPI:1407065600
Name:EARL M ADDICKS DDS PC
Entity Type:Organization
Organization Name:EARL M ADDICKS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:ADDICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-526-4750
Mailing Address - Street 1:2025 SUFFOLK RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-1633
Mailing Address - Country:US
Mailing Address - Phone:410-526-4750
Mailing Address - Fax:
Practice Address - Street 1:2025 SUFFOLK RD
Practice Address - Street 2:SUITE 12
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1633
Practice Address - Country:US
Practice Address - Phone:410-526-4750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD091191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty