Provider Demographics
NPI:1790079697
Name:CANIZALES, YEREMI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEREMI
Middle Name:A
Last Name:CANIZALES
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 1:111 BATA BLVD STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1427
Mailing Address - Country:US
Mailing Address - Phone:410-939-3343
Mailing Address - Fax:410-939-9049
Practice Address - Street 1:111 BATA BLVD STE D
Practice Address - Street 2:SUITE D
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1427
Practice Address - Country:US
Practice Address - Phone:410-939-3343
Practice Address - Fax:410-939-9049
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist