Healthcare Provider Details

I. General information

NPI: 1427174333
Provider Name (Legal Business Name): DRS. DWORKIN AND CLEMENS OF CROSS KEYS DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HAMILL RD SUITE 266 SOUTH
BALTIMORE MD
21210-1806
US

IV. Provider business mailing address

2 HAMILL RD SUITE 266 SOUTH
BALTIMORE MD
21210-1806
US

V. Phone/Fax

Practice location:
  • Phone: 410-435-8400
  • Fax:
Mailing address:
  • Phone: 410-435-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4152
License Number StateMD

VIII. Authorized Official

Name: ALLAN M. DWORKIN
Title or Position: OWNER
Credential: D.D.S
Phone: 410-435-8400