Provider Demographics
NPI:1629208582
Name:WHITE MARSH PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:WHITE MARSH PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-725-4185
Mailing Address - Street 1:5430 CAMPBELL BOULEVARD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162
Mailing Address - Country:US
Mailing Address - Phone:443-725-4185
Mailing Address - Fax:443-725-4187
Practice Address - Street 1:5430 CAMPBELL BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5504
Practice Address - Country:US
Practice Address - Phone:443-725-4185
Practice Address - Fax:443-725-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty