Healthcare Provider Details

I. General information

NPI: 1780062125
Provider Name (Legal Business Name): CATONSVILLE ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD STE 160
CATONSVILLE MD
21228-4633
US

IV. Provider business mailing address

405 FREDERICK RD. #160
CATONSVILLE MD
21228
US

V. Phone/Fax

Practice location:
  • Phone: 410-719-7668
  • Fax:
Mailing address:
  • Phone: 410-719-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14947
License Number StateMD

VIII. Authorized Official

Name: DR. KUNWAR VIR
Title or Position: ENDODONTIST/OWNER
Credential: DMD
Phone: 410-719-7668