MEDICARE: HARBOR EAST DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	07526	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5033	OTHER	MD	BLUECROSS BLUESHIELD ID

General Provider Information

NPI Number	:	1184766370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR EAST DENTAL

Provider Business Mailing Address
First Line	:	1001 FLEET ST
Second Line	:	SUITE R
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4346
Country	:	US
Telephone Number	:	410-385-9966
Fax Number	:	410-385-0276

Provider Business Practice Location Address
First Line	:	1001 FLEET ST
Second Line	:	SUITE R
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4346
Country	:	US
Telephone Number	:	410-385-9966
Fax Number	:	410-385-0276

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VENICE KAREN PATERAKIS
Credential	:	D.D.S
Telephone Number	:	410-385-9966

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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Directions to “HARBOR EAST DENTAL ” Practice Location

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