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General NPI Number Information
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NPI Number | 1215359625
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Entity Type | Organization
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Legal Business Name | CHEERFUL DENTAL PC
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 301 EASTERN BLVD SUITE 1
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City | BALTIMORE
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State | MD
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Zip | 21221-6940
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Country | US
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Telephone | 410-574-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 301 EASTERN BLVD SUITE 1
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City | BALTIMORE
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State | MD
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Zip | 21221-6940
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Country | US
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Telephone | 410-574-2454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIE C MIRANDA
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Credential | DDS
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Telephone | 410-574-2454
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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 | 11018
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License Number State | MD
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