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General NPI Number Information
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NPI Number | 1396903704
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Entity Type | Organization
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Legal Business Name | COSMETIC SMILE AND DENTURE TECHNOLOGY CONSULTANTS LLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 9199 REISTERSTOWN ROAD SUITE 203A
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City | OWINGS MILLS
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State | MD
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Zip | 21117
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Country | US
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Telephone | 410-433-9656
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 39395
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City | BALTO
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State | MD
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Zip | 21212-6395
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Country | US
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Telephone | 410-433-9656
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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. ROSLYN ROXANNA ROBINSON-KELLUM
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Credential | DDS
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Telephone | 410-433-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10848
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License Number State | MD
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