Provider Demographics
NPI:1629038294
Name:DENTAL DESIGN STUDIO INC
Entity Type:Organization
Organization Name:DENTAL DESIGN STUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR DENTIST PRESIDENT OF CORPORA
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BAIN
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-797-9119
Mailing Address - Street 1:222 E OAK RIDGE DR
Mailing Address - Street 2:STE 700
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-797-9119
Mailing Address - Fax:301-797-4925
Practice Address - Street 1:222 E OAK RIDGE DR
Practice Address - Street 2:STE 700
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-797-9119
Practice Address - Fax:301-797-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD7900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty