Provider Demographics
NPI:1629127386
Name:PAK DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:PAK DENTAL ASSOCIATES, PC
Other - Org Name:ELITE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-461-1166
Mailing Address - Street 1:10326 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2128
Mailing Address - Country:US
Mailing Address - Phone:410-461-1166
Mailing Address - Fax:410-461-1470
Practice Address - Street 1:10326 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2128
Practice Address - Country:US
Practice Address - Phone:410-461-1166
Practice Address - Fax:410-461-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD365500800Medicaid