Healthcare Provider Details

I. General information

NPI: 1861660839
Provider Name (Legal Business Name): RICHARD A. FEIN, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 CENTRE PARK DR SUITE 210
COLUMBIA MD
21045-2126
US

IV. Provider business mailing address

8808 CENTRE PARK DR SUITE 210
COLUMBIA MD
21045-2126
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-9600
  • Fax:
Mailing address:
  • Phone: 410-772-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number11132
License Number StateMD

VIII. Authorized Official

Name: DR. RICHARD FEIN
Title or Position: PRESIDENT
Credential: DMD
Phone: 410-772-9600