Provider Demographics
NPI:1710227863
Name:DENTAL ASSOCIATES OF GREATER MARYLAND
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF GREATER MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-997-8383
Mailing Address - Street 1:6339 ALLENTOWN RD STE E
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2600
Mailing Address - Country:US
Mailing Address - Phone:301-449-2800
Mailing Address - Fax:
Practice Address - Street 1:6339 ALLENTOWN RD STE E
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-2600
Practice Address - Country:US
Practice Address - Phone:301-449-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13144261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020167700Medicaid