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General NPI Number Information
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NPI Number | 1336902097
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Entity Type | Organization
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Legal Business Name | CARROLL COUNTY PEDIATRIC DENTISTRY & ORTHODONTICS
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 205 WASHINGTON HEIGHTS MEDICAL CENTER
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City | WESTMINSTER
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State | MD
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Zip | 21157
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Country | US
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Telephone | 443-487-9435
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 MUSGROVE ROAD
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City | TIMONIUM
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State | MD
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Zip | 21093
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Country | US
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Telephone | 410-935-8016
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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. MARSHALL WESLEY FESCHE
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Credential | D.D.S.
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Telephone | 410-935-8016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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