Healthcare Provider Details

I. General information

NPI: 1871788430
Provider Name (Legal Business Name): ORAL MEDICINE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST ROOM 7251
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST ROOM 7251
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7625
  • Fax: 410-706-0519
Mailing address:
  • Phone: 410-706-7625
  • Fax: 410-706-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5921
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY FRANCIS MEILLER
Title or Position: DIRECTOR OF ORAL MEDICINE
Credential: DDS, PHD
Phone: 410-706-7625