Healthcare Provider Details

I. General information

NPI: 1558395483
Provider Name (Legal Business Name): ENDODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 HONEYGO BLVD
BALTIMORE MD
21236-4931
US

IV. Provider business mailing address

15 OLD LYME RD
LUTHERVILLE MD
21093-3719
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-0250
  • Fax: 410-931-4876
Mailing address:
  • Phone: 410-560-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES MANN
Title or Position: OWNER/PRESIDENT
Credential: D.M.D
Phone: 410-931-0250