Individual
DR. SAMUEL CHARLES HAVRILAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2419 E JOPPA RD, BALTIMORE, MD 21234
(410) 668-5035
(410) 668-5036
Mailing address
2419 E JOPPA RD, BALTIMORE, MD 21234
(410) 668-5035
(410) 668-5036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6146
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3154
MARYLAND DENTAL PLAN
MD
Enumeration date
08/30/2006
Last updated
07/08/2007
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