Healthcare Provider Details

I. General information

NPI: 1629298146
Provider Name (Legal Business Name): SANDRA GARBELY KERKOVICH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BLOOMINGDALE AVE
FEDERALSBURG MD
21632-1012
US

IV. Provider business mailing address

215 BLOOMINGDALE AVE
FEDERALSBURG MD
21632-1012
US

V. Phone/Fax

Practice location:
  • Phone: 410-754-7583
  • Fax: 833-916-1013
Mailing address:
  • Phone: 410-754-7583
  • Fax: 833-916-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: