Provider Demographics
NPI:1437938644
Name:IRENE SPATES DMD LLC
Entity Type:Organization
Organization Name:IRENE SPATES DMD LLC
Other - Org Name:SPARKLING CHARMS DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:443-681-6455
Mailing Address - Street 1:887 E FORT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5117
Mailing Address - Country:US
Mailing Address - Phone:443-681-6455
Mailing Address - Fax:
Practice Address - Street 1:887 E FORT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5117
Practice Address - Country:US
Practice Address - Phone:443-269-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty