Provider Demographics
NPI:1245494962
Name:WHOLISTIC DENTAL CONCEPTS INC.
Entity type:Organization
Organization Name:WHOLISTIC DENTAL CONCEPTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-542-6900
Mailing Address - Street 1:5418 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4645
Mailing Address - Country:US
Mailing Address - Phone:410-524-6900
Mailing Address - Fax:410-542-6907
Practice Address - Street 1:5418 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-4645
Practice Address - Country:US
Practice Address - Phone:410-524-6900
Practice Address - Fax:410-542-6907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLISTIC DENTAL CONCEPTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty