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General NPI Number Information
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NPI Number | 1306185061
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Entity Type | Organization
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Legal Business Name | BLUE SKY DENTAL CARE
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 2120 BLUE SPRUCE DR E #B
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City | BEL AIR
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State | MD
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Zip | 21015-6802
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Country | US
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Telephone | 410-569-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 BLUE SPRUCE DR E #B
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City | BEL AIR
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State | MD
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Zip | 21015-6802
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Country | US
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Telephone | 410-569-9492
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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. DANIEL M MCLELLAN
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Credential | DDS
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Telephone | 410-569-9492
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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 | 13486
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License Number State | MD
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