Provider Demographics
NPI:1801207717
Name:ERLINDA E. EMBUSCADO DDS LLC
Entity Type:Organization
Organization Name:ERLINDA E. EMBUSCADO DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERLINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMBUSCADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-322-4847
Mailing Address - Street 1:731 DEEPDENE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2153
Mailing Address - Country:US
Mailing Address - Phone:410-323-3990
Mailing Address - Fax:410-323-2246
Practice Address - Street 1:731 DEEPDENE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2153
Practice Address - Country:US
Practice Address - Phone:410-323-3990
Practice Address - Fax:410-323-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty