Provider Demographics
NPI:1407388994
Name:FCI DENTAL CARE
Entity Type:Organization
Organization Name:FCI DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SACCOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-679-4500
Mailing Address - Street 1:413 PULASKI HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3626
Mailing Address - Country:US
Mailing Address - Phone:410-679-4500
Mailing Address - Fax:410-679-4445
Practice Address - Street 1:413 PULASKI HWY STE 107
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3626
Practice Address - Country:US
Practice Address - Phone:410-679-4500
Practice Address - Fax:410-679-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13055122300000X
MD1223P0221X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty