Provider Demographics
NPI:1417575424
Name:EASTON KIDS DENTIST LLC
Entity Type:Organization
Organization Name:EASTON KIDS DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LEWIS-MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-822-7575
Mailing Address - Street 1:613 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4304
Mailing Address - Country:US
Mailing Address - Phone:410-822-7575
Mailing Address - Fax:410-763-8929
Practice Address - Street 1:613 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4304
Practice Address - Country:US
Practice Address - Phone:410-822-7575
Practice Address - Fax:410-763-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty