MEDICARE: BALTIMORE CITY DENTAL GROUP

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	122300000X	Dentist	15443	MD

General Provider Information

NPI Number	:	1366988719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALTIMORE CITY DENTAL GROUP

Provider Business Mailing Address
First Line	:	300 N CHARLES ST
Second Line	:	STE D
City	:	BALTIMORE
State	:	MD
Zip	:	21201-4305
Country	:	US
Telephone Number	:	410-685-0002
Fax Number	:	410-244-5001

Provider Business Practice Location Address
First Line	:	300 N CHARLES ST
Second Line	:	STE D
City	:	BALTIMORE
State	:	MD
Zip	:	21201-4305
Country	:	US
Telephone Number	:	410-685-0002
Fax Number	:	410-244-5001

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHRISTIN DAMRON
Credential	:
Telephone Number	:	410-353-2820

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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