Healthcare Provider Details

I. General information

NPI: 1013796663
Provider Name (Legal Business Name): SHINITA R GOLDEN RDH, BS, QDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GARRISON BLVD
BALTIMORE MD
21216-2335
US

IV. Provider business mailing address

2300 GARRISON BLVD
BALTIMORE MD
21216-2335
US

V. Phone/Fax

Practice location:
  • Phone: 410-947-0606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8639
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: