Healthcare Provider Details

I. General information

NPI: 1346971058
Provider Name (Legal Business Name): JULIO ABRAHAN BERMUDEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 RITCHIE HWY STE 102
PASADENA MD
21122-1074
US

IV. Provider business mailing address

1211 S CONKLING ST APT 513
BALTIMORE MD
21224-5349
US

V. Phone/Fax

Practice location:
  • Phone: 954-483-6999
  • Fax:
Mailing address:
  • Phone: 954-483-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: