Healthcare Provider Details

I. General information

NPI: 1386891851
Provider Name (Legal Business Name): DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 SUFFOLK RD STE A
FINKSBURG MD
21048-1630
US

IV. Provider business mailing address

2029 SUFFOLK RD STE A
FINKSBURG MD
21048-1630
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-8900
  • Fax: 410-861-8445
Mailing address:
  • Phone: 410-861-8900
  • Fax: 410-861-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5382
License Number StateMD

VIII. Authorized Official

Name: DR. MARSHALL W. FESCHE
Title or Position: OWNER
Credential: D.D.S.
Phone: 410-848-5577