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General NPI Number Information
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NPI Number | 1851965057
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Entity Type | Organization
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Legal Business Name | SEVERNA PARK SMILES LLC
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 479 JUMPERS HOLE RD STE 201
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1729
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Country | US
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Telephone | 410-544-4444
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Fax | 410-544-7476
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Provider Business Mailing Address
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Address Line | 479 JUMPERS HOLE RD STE 201
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1729
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Country | US
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Telephone | 410-544-4444
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Fax | 410-544-7476
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIN KAY PALUCHOWSKI
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Credential | DDS
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Telephone | 410-544-4444
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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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