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Organization
PROVIDENCE DENTAL SPECIALISTS
Active
Organization
PROVIDENCE DENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EILEEN BUCKLE DDS (DENTIST)
(443) 858-8377
Entity
Organization
Contact information
Practice address
1215 ANNAPOLIS RD STE 205, ODENTON, MD 21113-1346
(443) 858-8377
Mailing address
1215 ANNAPOLIS RD STE 205, ODENTON, MD 21113-1346
(443) 858-8377
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
16121
MD
Other
Enumeration date
03/15/2016
Last updated
10/02/2024
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