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General NPI Number Information
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NPI Number | 1669170221
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Entity Type | Organization
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Legal Business Name | EMMITSBURG DENTAL CENTER, LLC
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 101 S SETON AVE
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City | EMMITSBURG
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State | MD
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Zip | 21727-9244
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Country | US
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Telephone | 301-447-6662
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Fax | 301-447-6663
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Provider Business Mailing Address
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Address Line | PO BOX 538
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City | EMMITSBURG
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State | MD
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Zip | 21727-0538
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Country | US
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Telephone | 301-447-6662
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Fax | 301-447-6663
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | CYNTHIA KNEDEISEN
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Credential |
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Telephone | 301-447-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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