Healthcare Provider Details

I. General information

NPI: 1487098885
Provider Name (Legal Business Name): CARL JUSTIN OPPENHEIM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1545
US

IV. Provider business mailing address

14333 LAUREL BOWIE RD SUITE 100
LAUREL MD
20708-1126
US

V. Phone/Fax

Practice location:
  • Phone: 410-458-3862
  • Fax:
Mailing address:
  • Phone: 301-953-2042
  • Fax: 301-725-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: