Healthcare Provider Details

I. General information

NPI: 1225533763
Provider Name (Legal Business Name): JOSHUA P WEINTRAUB DDS,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10407 STEVENSON RD
STEVENSON MD
21153-0600
US

IV. Provider business mailing address

10407 STEVENSON RD
STEVENSON MD
21153-0600
US

V. Phone/Fax

Practice location:
  • Phone: 410-764-8500
  • Fax: 410-764-8504
Mailing address:
  • Phone: 410-764-8500
  • Fax: 410-764-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number12513
License Number StateMD

VIII. Authorized Official

Name: MISS EMILY PERRY
Title or Position: FRONT DESK COORDINATOR
Credential:
Phone: 410-764-8526