Organization
KIDS DENTAL SPACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROXANNE PATREACE CLARKE DDS (PEDIATRIC DENTIST/OWNER)
(301) 537-5536
Entity
Organization
Contact information
Practice address
7402 YORK RD STE 204, TOWSON, MD 21204-7520
(301) 537-5536
Mailing address
8617 GOLDENWOOD RD, ROSEDALE, MD 21237-2032
(301) 537-5536
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046568200
—
MD
01
—
1326279829
NPI
MD
Enumeration date
04/02/2022
Last updated
04/02/2022
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