Healthcare Provider Details

I. General information

NPI: 1619334117
Provider Name (Legal Business Name): STEPHANIE L DENNISON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST STE 1465
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7101
  • Fax:
Mailing address:
  • Phone: 410-706-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15834
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL758
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: