Organization
BALTIMORE SOUTH SMILES YOUTH DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENELL STUMP (MANAGER, LICENSING CREDENTIALING)
(615) 750-0343
Entity
Organization
Contact information
Practice address
2111 W PATAPSCO AVE, BALTIMORE, MD 21230-2946
(410) 644-4100
(410) 644-4594
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062375100
—
DC
01
—
111229
DENTAQUEST
MD
05
—
410647400
—
MD
Enumeration date
08/11/2006
Last updated
07/09/2014
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