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General NPI Number Information
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NPI Number | 1275927089
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DENTAL AT WATER'S EDGE LLC
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 111 BATA BLVD STE D
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City | BELCAMP
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State | MD
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Zip | 21017-1427
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Country | US
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Telephone | 410-272-1535
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Fax | 410-272-0242
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Provider Business Mailing Address
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Address Line | 111 BATA BLVD STE D
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City | BELCAMP
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State | MD
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Zip | 21017-1427
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Country | US
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Telephone | 410-272-1535
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Fax | 410-272-0242
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Authorized Official
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Title or Position | OWNER
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Name | DR. NEELU MILAK
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Credential |
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Telephone | 410-272-1535
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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 | D38111
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License Number State | MD
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