Healthcare Provider Details

I. General information

NPI: 1407388994
Provider Name (Legal Business Name): FCI DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 PULASKI HWY STE 107
JOPPA MD
21085-3626
US

IV. Provider business mailing address

413 PULASKI HWY STE 107
JOPPA MD
21085-3626
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-4500
  • Fax: 410-679-4445
Mailing address:
  • Phone: 410-679-4500
  • Fax: 410-679-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13055
License Number StateMD

VIII. Authorized Official

Name: MR. MOHAMED L SACCOH
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 410-679-4500