Organization
YEREMI A CANIZALES DDS P A
Active
Other names
Severn River Dental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
YEREMI ANTONIO CANIZALES DDS (OWNER)
(410) 647-4094
Entity
Organization
Contact information
Practice address
572 RITCHIE HWY STE F, SEVERNA PARK, MD 21146-2966
(410) 647-4094
Mailing address
572 RITCHIE HWY STE F, SEVERNA PARK, MD 21146-2966
(410) 647-4094
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14933
MD
1223P0700X
Prosthodontics
14819
MD
124Q00000X
Dental Hygienist
6912
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790079697
NPI
MD
Enumeration date
09/21/2015
Last updated
08/09/2019
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