MEDICARE: KERNAN DENTISTRY

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	261QD0000X	Dental Clinic/Center		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9282-1	OTHER	MD	UNITED HEALTHCARE ID
2	S165	OTHER	MD	DENTAL NETWORK ID
3	105664	OTHER	MD	DORAL DENTAL LOCATION ID
4	164252	OTHER	MD	DORAL DENTAL PAYOR ID
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942202692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERNAN DENTISTRY

Provider Business Mailing Address
First Line	:	PO BOX 62015
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-2015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 KERNAN DR
Second Line	:	DENTAL SUITE T500
City	:	BALTIMORE
State	:	MD
Zip	:	21207-6665
Country	:	US
Telephone Number	:	410-448-6290
Fax Number	:	410-448-6883

Authorized Official
Title or Position	:	CFO
Name	:	MARINA BOGIN
Credential	:
Telephone Number	:	410-448-6289

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	06/27/2023

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Directions to “KERNAN DENTISTRY ” Practice Location

Language	Start Address	Practice Location

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