Healthcare Provider Details

I. General information

NPI: 1326380205
Provider Name (Legal Business Name): DENTAQUEST MID-ATLANTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 POWDER MILL RD SUITE 325
CALVERTON MD
20705-3149
US

IV. Provider business mailing address

465 MEDFORD ST
BOSTON MA
02129-1426
US

V. Phone/Fax

Practice location:
  • Phone: 617-886-1818
  • Fax:
Mailing address:
  • Phone: 617-886-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES HAWKINS
Title or Position: SECRETARY
Credential:
Phone: 617-886-1511