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General NPI Number Information
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NPI Number | 1104226653
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Entity Type | Organization
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Legal Business Name | SKP FAMILY DENTAL
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 7525 GREENWAY CENTER DR STE 310
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City | GREENBELT
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State | MD
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Zip | 20770-3525
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Country | US
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Telephone | 240-553-7772
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Fax | 240-553-7782
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Provider Business Mailing Address
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Address Line | 7525 GREENWAY CENTER DR STE 310
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City | GREENBELT
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State | MD
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Zip | 20770-3525
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Country | US
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Telephone | 240-553-7772
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Fax | 240-553-7782
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAULOS F DALU
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Credential |
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Telephone | 240-553-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 15553
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License Number State | MD
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