Provider Demographics
NPI:1669859435
Name:SAMUEL WEALCATCH, D.D.S., P.A.
Entity Type:Organization
Organization Name:SAMUEL WEALCATCH, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEALCATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-602-1800
Mailing Address - Street 1:1700 REISTERSTOWN RD
Mailing Address - Street 2:106-107
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1416
Mailing Address - Country:US
Mailing Address - Phone:410-602-1800
Mailing Address - Fax:
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:106-107
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-602-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10450261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental