Provider Demographics
NPI:1942575964
Name:MARYLAND PROSTHODONTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:MARYLAND PROSTHODONTIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SINADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-519-5293
Mailing Address - Street 1:6569 N CHARLES ST
Mailing Address - Street 2:PHYSICIANS PAVILION WEST, SUITE 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6831
Mailing Address - Country:US
Mailing Address - Phone:443-519-5293
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:PHYSICIANS PAVILION WEST, SUITE 601
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:443-519-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128521223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty