Healthcare Provider Details

I. General information

NPI: 1477674588
Provider Name (Legal Business Name): ENDODONTIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RESERVOIR CIR #102
BALTIMORE MD
21208-6324
US

IV. Provider business mailing address

8 RESERVOIR CIR #102
BALTIMORE MD
21208-6324
US

V. Phone/Fax

Practice location:
  • Phone: 410-653-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12523
License Number StateMD

VIII. Authorized Official

Name: HOWARD MICHAEL COHEN
Title or Position: ENDODONTIST
Credential: D.D.S.
Phone: 410-653-2020