Organization
DIVINE DENTAL LLC
Active
Parent organization
DIVINE DENTAL LLC
Other names
Brooklyn Park Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE DENTAL LLC
Authorized official
MARYELLEN DESROCHERS (OFFICE MANAGER)
(410) 789-5228
Entity
Organization
Contact information
Practice address
4801 RITCHIE HWY, BALTIMORE, MD 21225-3045
(410) 789-5228
(410) 789-2162
Mailing address
4801 RITCHIE HWY, BALTIMORE, MD 21225-3045
(410) 789-5228
(410) 789-2162
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7069
MD
Other
Enumeration date
07/12/2010
Last updated
11/14/2023
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