| Joppa Green Pediatric Dentistry | |
|
2324 W Joppa Rd Suite 430 Lutherville MD 21093-4615 | |
| (410) 321-0200 | |
| Not Available |
| Full Name | Joppa Green Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2324 W Joppa Rd, Lutherville, Maryland |
| Authorized Official Name and Position | Lisa Black (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 4103210200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Joppa Green Pediatric Dentistry 2324 W Joppa Rd Suite 430 Lutherville MD 21093-4615 Ph: (410) 321-0200 | Joppa Green Pediatric Dentistry 2324 W Joppa Rd Suite 430 Lutherville MD 21093-4615 Ph: (410) 321-0200 |
| NPI Number | 1851769731 |
|---|---|
| Provider Enumeration Date | 09/09/2015 |
| Last Update Date | 09/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851769731 | NPI | - | NPPES |
| 040520500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 12747 (Maryland) | Primary |
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