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General NPI Number Information
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NPI Number | 1790079697
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Entity Type | Individual
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Provider Name | YEREMI A CANIZALES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 111 BATA BLVD STE D SUITE D
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City | BELCAMP
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State | MD
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Zip | 21017-1427
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Country | US
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Telephone | 410-939-3343
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Fax | 410-939-9049
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Provider Business Mailing Address
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Address Line | 111 BATA BLVD STE D SUITE D
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City | BELCAMP
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State | MD
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Zip | 21017-1427
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Country | US
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Telephone | 410-939-3343
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Fax | 410-939-9049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14933
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License Number State | MD
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