Healthcare Provider Details

I. General information

NPI: 1548788730
Provider Name (Legal Business Name): EAST POINT PEDIATRIC DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N POINT BLVD STE 503
BALTIMORE MD
21224-3413
US

IV. Provider business mailing address

1001 N POINT BLVD STE 503
BALTIMORE MD
21224-3413
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-8900
  • Fax: 410-282-1126
Mailing address:
  • Phone: 410-282-8900
  • Fax: 410-282-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WARREN A BRILL
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 410-282-8900