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Organization
OPNE WIDE LLC
Active
Organization
OPNE WIDE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRANCE SHATEEK LAWRENCE (DENTAL LAB TECHNICIAN)
(410) 258-0189
Entity
Organization
Contact information
Practice address
221 S FULTON AVE, BALTIMORE, MD 21223-3004
(410) 258-0189
Mailing address
221 S FULTON AVE, BALTIMORE, MD 21223-3004
(410) 258-0189
Taxonomy
Speciality
Code
Description
License number
State
126900000X
Dental Laboratory Technician
Primary
—
NULL
126900000X
Dental Laboratory Technician
Primary
—
—
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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