Provider Demographics
NPI:1699811901
Name:PILGRIM, KARL O (DDS)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:O
Last Name:PILGRIM
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 1:3611 BRANCH AVE
Mailing Address - Street 2:SUITE #301
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1242
Mailing Address - Country:US
Mailing Address - Phone:301-326-3409
Mailing Address - Fax:301-702-2777
Practice Address - Street 1:3611 BRANCH AVE
Practice Address - Street 2:SUITE #301
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-326-3409
Practice Address - Fax:301-702-2777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9181185,167043Medicaid