Individual
RAYMOND BRENT MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9712 BELAIR RD STE 200, BALTIMORE, MD 21236-1112
(410) 256-1715
(410) 256-1765
Mailing address
9712 BELAIR RD STE 200, BALTIMORE, MD 21236-1112
(410) 256-1715
(410) 256-1765
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6437
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6437
LICENSE #
MD
Enumeration date
11/08/2006
Last updated
07/08/2007
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