Healthcare Provider Details

I. General information

NPI: 1164505368
Provider Name (Legal Business Name): NORMAN TINANOFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W. BALTIMORE ST. 5 SOUTH RM 5102
BALTIMORE MD
21201
US

IV. Provider business mailing address

650 W. BALTIMORE ST. 5 SOUTH RM 5102
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7970
  • Fax: 410-706-3028
Mailing address:
  • Phone: 410-706-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5034
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: