Provider Demographics
NPI:1295487155
Name:FULTON PEDIATRIC DENTAL
Entity type:Organization
Organization Name:FULTON PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-726-2548
Mailing Address - Street 1:8120 WESTSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2587
Mailing Address - Country:US
Mailing Address - Phone:410-726-2548
Mailing Address - Fax:
Practice Address - Street 1:11810 W MARKET PL STE 202
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2703
Practice Address - Country:US
Practice Address - Phone:410-988-4647
Practice Address - Fax:410-696-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty