Healthcare Provider Details

I. General information

NPI: 1447346820
Provider Name (Legal Business Name): TOWSON PERIODONTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E JOPPA RD SUITE 200
TOWSON MD
21286-5419
US

IV. Provider business mailing address

521 E JOPPA RD SUITE 200
TOWSON MD
21286-5419
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-9477
  • Fax: 410-321-9607
Mailing address:
  • Phone: 410-321-9477
  • Fax: 410-321-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number05792
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. THOMAS E. DALEY
Title or Position: OWNER
Credential: D.D.S.
Phone: 410-321-9477