Provider Demographics
NPI:1578736955
Name:GRACE DENTAL CLINIC, P.A.
Entity Type:Organization
Organization Name:GRACE DENTAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KEUNYOUNG
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-997-5699
Mailing Address - Street 1:8850 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2374
Mailing Address - Country:US
Mailing Address - Phone:410-997-5699
Mailing Address - Fax:410-997-5633
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2374
Practice Address - Country:US
Practice Address - Phone:410-997-5699
Practice Address - Fax:410-997-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13555261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental