Basic Information
| Provider Information | |||||||||
| NPI: | 1457748121 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH BAY FAMILY DENTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3135 JOSEPH BIGGS MEMORIAL HWY | ||||||||
| Address2: | SUITE 2B | ||||||||
| City: | NORTH EAST | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219011839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109833000 | ||||||||
| FaxNumber: | 4105675449 | ||||||||
| Practice Location | |||||||||
| Address1: | 3135 JOSEPH BIGGS MEMORIAL HWY | ||||||||
| Address2: | SUITE 2B | ||||||||
| City: | NORTH EAST | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219011839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109833000 | ||||||||
| FaxNumber: | 4105675449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | GATES | ||||||||
| AuthorizedOfficialFirstName: | MINDA | ||||||||
| AuthorizedOfficialMiddleName: | BETH | ||||||||
| AuthorizedOfficialTitleorPosition: | RECEPTION | ||||||||
| AuthorizedOfficialTelephone: | 4109833000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 13880 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.