Provider Demographics
NPI:1760643795
Name:CHURCHVILLE DENTAL CARE, INC.
Entity Type:Organization
Organization Name:CHURCHVILLE DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LIOI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-838-1133
Mailing Address - Street 1:2832A CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1620
Mailing Address - Country:US
Mailing Address - Phone:410-838-1133
Mailing Address - Fax:410-838-1134
Practice Address - Street 1:2832A CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1620
Practice Address - Country:US
Practice Address - Phone:410-838-1133
Practice Address - Fax:410-838-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty