Provider Demographics
NPI:1720844004
Name:WINGFIELD, MARIE BERNADETTE (RDH, BSDH)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:BERNADETTE
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13213 CHOPTANK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1106
Mailing Address - Country:US
Mailing Address - Phone:240-271-2042
Mailing Address - Fax:
Practice Address - Street 1:7650 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-668-5151
Practice Address - Fax:410-661-5055
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6704124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist