Healthcare Provider Details

I. General information

NPI: 1982146403
Provider Name (Legal Business Name): CRISTINA ALARCON DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LASALLE RD, YORK BUILDING SUITE 500
TOWSON MD
21286
US

IV. Provider business mailing address

2721 HARRIS LN
BALTIMORE MD
21224-3860
US

V. Phone/Fax

Practice location:
  • Phone: 443-846-0130
  • Fax:
Mailing address:
  • Phone: 410-693-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14371
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier002072900
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: DR. MARIA CRISTINA ALARCON
Title or Position: PRESIDENT
Credential: DDS
Phone: 443-846-0130