Healthcare Provider Details

I. General information

NPI: 1952993628
Provider Name (Legal Business Name): ULERY DENTAL AND ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MERRITT BLVD
DUNDALK MD
21222-1438
US

IV. Provider business mailing address

600 TECHNOLOGY PARK STE 101
LAKE MARY FL
32746-7122
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-8200
  • Fax: 410-650-4037
Mailing address:
  • Phone: 800-786-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN RAMKISHUN
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 407-543-8509