Basic Information
| Provider Information | |||||||||
| NPI: | 1063595163 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARRETT COUNTY HEALTH DEPARTMENT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DENTAL CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215504343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013377700 | ||||||||
| FaxNumber: | 3013347701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215504343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013377700 | ||||||||
| FaxNumber: | 3013347701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SKILES | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3013347703 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.