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General NPI Number Information
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NPI Number | 1457784670
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Entity Type | Organization
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Legal Business Name | WESTMINSTER FAMILY DENTISTRY, LLC.
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 115 AIRPORT DR SUITE 110
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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 | 443-244-9222
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Fax | 410-505-8921
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Provider Business Mailing Address
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Address Line | 115 AIRPORT DR SUITE 110
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City | WESTMINSTER
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State | MD
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Zip | 21157-3056
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Country | US
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Telephone | 443-244-9222
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Fax | 410-505-8921
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | ANNE ETZKORN
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Credential | DDS
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Telephone | 443-244-9222
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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 | 15147
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License Number State | MD
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