Provider Demographics
NPI:1790478238
Name:BALTIMORE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:BALTIMORE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-379-4085
Mailing Address - Street 1:1838 GREENE TREE RD STE 270
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-7108
Mailing Address - Country:US
Mailing Address - Phone:443-379-4085
Mailing Address - Fax:
Practice Address - Street 1:1838 GREENE TREE RD STE 270
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7108
Practice Address - Country:US
Practice Address - Phone:443-379-4085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental