Provider Demographics
NPI:1497969208
Name:CHESAPEAKE BAY DENTAL PA
Entity Type:Organization
Organization Name:CHESAPEAKE BAY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMEEM
Authorized Official - Middle Name:AARA
Authorized Official - Last Name:BHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-273-5446
Mailing Address - Street 1:328 N PHILADELPHIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1910
Mailing Address - Country:US
Mailing Address - Phone:410-273-5446
Mailing Address - Fax:
Practice Address - Street 1:328 N PHILADELPHIA BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1910
Practice Address - Country:US
Practice Address - Phone:410-273-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty