Provider Demographics
NPI:1457355786
Name:URGENT DENTAL CARE CLINIC, INC.
Entity Type:Organization
Organization Name:URGENT DENTAL CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-572-6331
Mailing Address - Street 1:P. O. BOX 2358 SNOW HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802
Mailing Address - Country:US
Mailing Address - Phone:410-572-6331
Mailing Address - Fax:410-572-6253
Practice Address - Street 1:926 SNOW HILL RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1939
Practice Address - Country:US
Practice Address - Phone:410-572-6331
Practice Address - Fax:410-572-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115281223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD106151Medicaid
MD230174Medicaid