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General NPI Number Information
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NPI Number | 1407388994
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Entity Type | Organization
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Legal Business Name | FCI DENTAL CARE
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 413 PULASKI HWY STE 107
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City | JOPPA
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State | MD
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Zip | 21085-3626
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Country | US
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Telephone | 410-679-4500
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Fax | 410-679-4445
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Provider Business Mailing Address
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Address Line | 413 PULASKI HWY STE 107
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City | JOPPA
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State | MD
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Zip | 21085-3626
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Country | US
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Telephone | 410-679-4500
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Fax | 410-679-4445
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | MR. MOHAMED L SACCOH
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Credential | DDS
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Telephone | 410-679-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MD
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13055
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License Number State | MD
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