Provider Demographics
NPI: | 1952953267 |
---|---|
Name: | RADPARVAR SMILES R US AT ELLICOTT CITY P.C. |
Entity Type: | Organization |
Organization Name: | RADPARVAR SMILES R US AT ELLICOTT CITY P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AMBER |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | ENGLAND |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 410-480-9800 |
Mailing Address - Street 1: | 9200 BALTIMORE NATIONAL PIKE STE E |
Mailing Address - Street 2: | |
Mailing Address - City: | ELLICOTT CITY |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21042-2613 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-480-9800 |
Mailing Address - Fax: | 410-480-9808 |
Practice Address - Street 1: | 9200 BALTIMORE NATIONAL PIKE STE E |
Practice Address - Street 2: | |
Practice Address - City: | ELLICOTT CITY |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21042-2613 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-480-9800 |
Practice Address - Fax: | 410-480-9808 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-07-16 |
Last Update Date: | 2019-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |