Provider Demographics
NPI:1336924737
Name:FIRST DENTAL
Entity Type:Organization
Organization Name:FIRST DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUJI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-323-2875
Mailing Address - Street 1:5710 BELLONA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3500
Mailing Address - Country:US
Mailing Address - Phone:410-323-2875
Mailing Address - Fax:
Practice Address - Street 1:5710 BELLONA AVE STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3500
Practice Address - Country:US
Practice Address - Phone:410-323-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST DENTAL MARYLAND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty