Provider Demographics
NPI:1740717313
Name:DENTISTRY FOR CHILDREN
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-819-0726
Mailing Address - Street 1:508 CYNWOOD DR
Mailing Address - Street 2:STE. B
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3892
Mailing Address - Country:US
Mailing Address - Phone:410-819-0726
Mailing Address - Fax:
Practice Address - Street 1:508 CYNWOOD DR
Practice Address - Street 2:STE. B
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3892
Practice Address - Country:US
Practice Address - Phone:410-819-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109181223P0221X
MD140621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD162484900Medicaid