# OPNE WIDE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184492068
- **Authorized official:** TERRANCE SHATEEK LAWRENCE (DENTAL LAB TECHNICIAN)
- **Authorized official phone:** (410) 258-0189

## Contact information

- **Practice address:** 221 S FULTON AVE, BALTIMORE, MD 21223-3004
- **Practice address phone:** (410) 258-0189
- **Mailing address:** 221 S FULTON AVE, BALTIMORE, MD 21223-3004
- **Mailing address phone:** (410) 258-0189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 126900000X | Dental Laboratory Technician | — | NULL | Yes |
| 126900000X | Dental Laboratory Technician | — | — | Yes |

## Other

- **Enumeration date:** 12/19/2023
- **Last updated:** 12/19/2023