Provider Demographics
NPI:1942202692
Name:KERNAN DENTISTRY
Entity Type:Organization
Organization Name:KERNAN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-448-6289
Mailing Address - Street 1:PO BOX 62015
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 KERNAN DR
Practice Address - Street 2:DENTAL SUITE T500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-6665
Practice Address - Country:US
Practice Address - Phone:410-448-6290
Practice Address - Fax:410-448-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9282-1OtherUNITED HEALTHCARE ID
MDS165OtherDENTAL NETWORK ID
MD105664OtherDORAL DENTAL LOCATION ID
MD164252OtherDORAL DENTAL PAYOR ID
MD800194400Medicaid