Provider Demographics
NPI:1598770919
Name:MCMENAMIN, GLORIA ANNE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLORIA ANNE
Middle Name:J
Last Name:MCMENAMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:A
Other - Last Name:MCMENAMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS/DMD
Mailing Address - Street 1:8501 LASALLE RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5914
Mailing Address - Country:US
Mailing Address - Phone:410-339-5858
Mailing Address - Fax:410-339-3838
Practice Address - Street 1:8501 LASALLE RD
Practice Address - Street 2:SUITE 309
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5914
Practice Address - Country:US
Practice Address - Phone:410-339-5858
Practice Address - Fax:410-339-3838
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice