MEDICARE: RADPARVAR SMILES R US AT ELLICOTT CITY P.C.

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

General Provider Information

NPI Number	:	1952953267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADPARVAR SMILES R US AT ELLICOTT CITY P.C.

Provider Business Mailing Address
First Line	:	9200 BALTIMORE NATIONAL PIKE STE E
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2613
Country	:	US
Telephone Number	:	410-480-9800
Fax Number	:	410-480-9808

Provider Business Practice Location Address
First Line	:	9200 BALTIMORE NATIONAL PIKE STE E
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2613
Country	:	US
Telephone Number	:	410-480-9800
Fax Number	:	410-480-9808

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AMBER MARIE ENGLAND
Credential	:
Telephone Number	:	410-480-9800

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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