Provider Demographics
NPI:1982816815
Name:CONVENIENT DENTAL
Entity Type:Organization
Organization Name:CONVENIENT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYALAKSHMI
Authorized Official - Middle Name:NATARAJAN
Authorized Official - Last Name:ANGAMUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-281-7700
Mailing Address - Street 1:1726 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:410-281-7700
Mailing Address - Fax:410-281-1861
Practice Address - Street 1:1726 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244
Practice Address - Country:US
Practice Address - Phone:410-281-7700
Practice Address - Fax:410-281-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty