Healthcare Provider Details

I. General information

NPI: 1124126537
Provider Name (Legal Business Name): DRS. DELGADO & STANEK, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 INGLESIDE AVE
BALTIMORE MD
21228-1317
US

IV. Provider business mailing address

1006 INGLESIDE AVE
BALTIMORE MD
21228-1317
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-1707
  • Fax: 410-747-2608
Mailing address:
  • Phone: 410-747-1707
  • Fax: 410-747-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5889
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8801
License Number StateMD

VIII. Authorized Official

Name: GEORGE PATRICIO DELGADO
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 410-747-1707