Provider Demographics
NPI:1972378164
Name:EXPRESS DENTAL EMERGENCY SERVICES, LLC
Entity Type:Organization
Organization Name:EXPRESS DENTAL EMERGENCY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:AUBERT
Authorized Official - Last Name:TRUESDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-614-8812
Mailing Address - Street 1:1111 PARK AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 PARK AVE STE 109
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5656
Practice Address - Country:US
Practice Address - Phone:410-699-1077
Practice Address - Fax:410-383-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty