Provider Demographics
NPI:1356607097
Name:JACQUES P. EXPOSITO, D.D.S. P.A.
Entity type:Organization
Organization Name:JACQUES P. EXPOSITO, D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:PHILIPPE
Authorized Official - Last Name:EXPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-768-8220
Mailing Address - Street 1:1404 CRAIN HWY S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4085
Mailing Address - Country:US
Mailing Address - Phone:410-768-8220
Mailing Address - Fax:410-768-8252
Practice Address - Street 1:1404 CRAIN HWY S
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4085
Practice Address - Country:US
Practice Address - Phone:410-768-8220
Practice Address - Fax:410-768-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty