Provider Demographics
NPI:1609942515
Name:PEOPLE'S COMMUNITY HEALTH CENTER -DENTAL
Entity Type:Organization
Organization Name:PEOPLE'S COMMUNITY HEALTH CENTER -DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASSATT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS
Authorized Official - Phone:410-467-6040
Mailing Address - Street 1:2524 KIRK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4826
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:410-735-5897
Practice Address - Street 1:3011 GREENMOUNT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3939
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:410-735-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD913904400Medicaid