Baltimore South Smiles Youth Dentistry, Pc | |
2111 W Patapsco Ave Baltimore MD 21230-2946 | |
(410) 644-4100 | |
(410) 644-4594 |
Full Name | Baltimore South Smiles Youth Dentistry, Pc |
---|---|
Speciality | Dentist - General Practice |
Location | 2111 W Patapsco Ave, Baltimore, Maryland |
Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING CREDENTIALING) |
Authorized Official Contact | 6157500343 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Baltimore South Smiles Youth Dentistry, Pc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Baltimore South Smiles Youth Dentistry, Pc 2111 W Patapsco Ave Baltimore MD 21230-2946 Ph: (410) 644-4100 |
NPI Number | 1568473759 |
---|---|
Provider Enumeration Date | 08/11/2006 |
Last Update Date | 07/09/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568473759 | NPI | - | NPPES |
111229 | Other | MD | DENTAQUEST |
062375100 | Medicaid | DC | |
410647400 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
News Archive
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