Provider Demographics
NPI:1730287186
Name:BARRY W DAHL DMD PA
Entity Type:Organization
Organization Name:BARRY W DAHL DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-997-2020
Mailing Address - Street 1:10632 LITTLE PATUXENT PKWY
Mailing Address - Street 2:STE 105
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6256
Mailing Address - Country:US
Mailing Address - Phone:410-997-2020
Mailing Address - Fax:410-997-2020
Practice Address - Street 1:10632 LITTLE PATUCENT PKWY
Practice Address - Street 2:STE 105
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6256
Practice Address - Country:US
Practice Address - Phone:410-997-2020
Practice Address - Fax:410-997-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty