Healthcare Provider Details

I. General information

NPI: 1982104329
Provider Name (Legal Business Name): ANDREW NADEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WARREN RD STE 300
COCKEYSVILLE MD
21030-2506
US

IV. Provider business mailing address

14421 MAPLE RIDGE CT
BALDWIN MD
21013-9500
US

V. Phone/Fax

Practice location:
  • Phone: 410-220-5220
  • Fax:
Mailing address:
  • Phone: 443-904-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17325
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: