Healthcare Provider Details

I. General information

NPI: 1528153798
Provider Name (Legal Business Name): TIMOTHY J CARRION DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 RACE RD STE 302
BALTO MD
21237
US

IV. Provider business mailing address

1232 RACE RD STE 302
BALTO MD
21237-2382
US

V. Phone/Fax

Practice location:
  • Phone: 410-391-8301
  • Fax: 410-687-5110
Mailing address:
  • Phone: 410-391-8301
  • Fax: 410-687-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number7086
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: