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General NPI Number Information
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NPI Number | 1841287034
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Entity Type | Organization
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Legal Business Name | GREATER BALTIMORE PROSTHODONTICS PA
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 110 WEST RD SUITE 200
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City | TOWSON
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State | MD
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Zip | 21204-2316
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Country | US
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Telephone | 410-296-0136
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Fax | 410-828-4364
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Provider Business Mailing Address
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Address Line | 110 WEST RD SUITE 200
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City | TOWSON
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State | MD
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Zip | 21204-2316
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Country | US
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Telephone | 410-296-0136
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Fax | 410-828-4364
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL P LINNAN
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Credential | DDS PA
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Telephone | 410-296-0136
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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 | 13397
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 8468
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License Number State | MD
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