Provider Demographics
NPI:1790820918
Name:SHULMAN, MARK (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SHULMAN
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 1:8600 LASALLE ROAD
Mailing Address - Street 2:SUITE 406 SEVERN BLDG
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-321-0551
Mailing Address - Fax:410-821-5220
Practice Address - Street 1:8600 LASALLE ROAD
Practice Address - Street 2:SUITE 406 SEVERN BLDG
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-321-0551
Practice Address - Fax:410-821-5220
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5926122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice