Provider Demographics
NPI:1457748121
Name:NORTH BAY FAMILY DENTAL
Entity Type:Organization
Organization Name:NORTH BAY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTION
Authorized Official - Prefix:
Authorized Official - First Name:MINDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-983-3000
Mailing Address - Street 1:3135 JOSEPH BIGGS MEMORIAL HWY
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-1839
Mailing Address - Country:US
Mailing Address - Phone:410-983-3000
Mailing Address - Fax:410-567-5449
Practice Address - Street 1:3135 JOSEPH BIGGS MEMORIAL HWY
Practice Address - Street 2:SUITE 2B
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-1839
Practice Address - Country:US
Practice Address - Phone:410-983-3000
Practice Address - Fax:410-567-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty