Provider Demographics
NPI:1619206786
Name:TAUBENFELD, MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:TAUBENFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 GARDENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1508
Mailing Address - Country:US
Mailing Address - Phone:410-484-7487
Mailing Address - Fax:
Practice Address - Street 1:3505 GARDENVIEW RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1508
Practice Address - Country:US
Practice Address - Phone:410-484-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3178122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist