Healthcare Provider Details

I. General information

NPI: 1053482026
Provider Name (Legal Business Name): PERRY HALL DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8647 BELAIR RD
BALTIMORE MD
21236
US

IV. Provider business mailing address

8647 BELAIR RD
BALTIMORE MD
21236
US

V. Phone/Fax

Practice location:
  • Phone: 410-256-5550
  • Fax: 410-256-9567
Mailing address:
  • Phone: 410-256-5550
  • Fax: 410-256-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JOHN NICHOLAS STAMAS
Title or Position: OWNER PARTNER
Credential: DDS
Phone: 410-256-5550