Provider Demographics
NPI:1336902097
Name:CARROLL COUNTY PEDIATRIC DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:CARROLL COUNTY PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:FESCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-935-8016
Mailing Address - Street 1:1302 MUSGROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-935-8016
Mailing Address - Fax:
Practice Address - Street 1:205 WASHINGTON HEIGHTS MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:443-487-9435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty