Basic Information
| Provider Information | |||||||||
| NPI: | 1003108473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMALL SMILES DENTAL CENTER OF CENTRAL BALTIMORE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W 8TH ST | ||||||||
| Address2: | SUITE 810 | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810033038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195624447 | ||||||||
| FaxNumber: | 7195831801 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 N CAROLINE ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212051000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157500343 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | STRINGER | ||||||||
| AuthorizedOfficialFirstName: | JENELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6157500343 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.