Healthcare Provider Details

I. General information

NPI: 1629659628
Provider Name (Legal Business Name): STANLEY T DORROW DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD STE 302
PIKESVILLE MD
21208-6418
US

IV. Provider business mailing address

4000 OLD COURT RD STE 302
PIKESVILLE MD
21208-6418
US

V. Phone/Fax

Practice location:
  • Phone: 410-654-0052
  • Fax: 410-484-9761
Mailing address:
  • Phone: 410-654-0052
  • Fax: 410-484-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STANLEY T DORROW
Title or Position: DIRECTOR
Credential: DDS
Phone: 410-654-0052