Healthcare Provider Details

I. General information

NPI: 1407065600
Provider Name (Legal Business Name): EARL M ADDICKS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SUFFOLK RD SUITE 12
FINKSBURG MD
21048-1633
US

IV. Provider business mailing address

2025 SUFFOLK RD SUITE 12
FINKSBURG MD
21048-1633
US

V. Phone/Fax

Practice location:
  • Phone: 410-526-4750
  • Fax:
Mailing address:
  • Phone: 410-526-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number09119
License Number StateMD

VIII. Authorized Official

Name: DR. EARL MELVIN ADDICKS
Title or Position: PRESIDENT
Credential: DDS
Phone: 410-526-4750