Provider Demographics
NPI:1497923932
Name:CHESAPEAKE COSMETIC AND FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CHESAPEAKE COSMETIC AND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESCIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-990-4800
Mailing Address - Street 1:1610 WEST ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4055
Mailing Address - Country:US
Mailing Address - Phone:410-990-4800
Mailing Address - Fax:410-990-4869
Practice Address - Street 1:1610 WEST ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4055
Practice Address - Country:US
Practice Address - Phone:410-990-4800
Practice Address - Fax:410-990-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty