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General NPI Number Information
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NPI Number | 1043618374
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Entity Type | Organization
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Legal Business Name | PARK DENTAL
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 7304 E FURNACE BRANCH RD
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City | GLEN BURNIE
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State | MD
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Zip | 21060-7056
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Country | US
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Telephone | 410-424-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 7304 E FURNACE BRANCH RD
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City | GLEN BURNIE
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State | MD
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Zip | 21060-7056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HASSAN NUR
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Credential |
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Telephone | 443-850-0079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15404
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License Number State | MD
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