Healthcare Provider Details

I. General information

NPI: 1235703281
Provider Name (Legal Business Name): KRISTEN GRABOWSKI OBRECHT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPARKS VALLEY RD STE C
SPARKS GLENCOE MD
21152-9234
US

IV. Provider business mailing address

221 GOODALE RD
BALTIMORE MD
21212-3433
US

V. Phone/Fax

Practice location:
  • Phone: 410-771-8200
  • Fax:
Mailing address:
  • Phone: 410-800-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17697
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: