Healthcare Provider Details

I. General information

NPI: 1639053911
Provider Name (Legal Business Name): MARILYN OKINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD STE 201
PIKESVILLE MD
21208-2847
US

IV. Provider business mailing address

4000 OLD COURT RD STE 201
PIKESVILLE MD
21208-2847
US

V. Phone/Fax

Practice location:
  • Phone: 410-267-3039
  • Fax:
Mailing address:
  • Phone: 410-267-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18980
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: