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General NPI Number Information
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NPI Number | 1912303769
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Entity Type | Organization
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Legal Business Name | MISHPACHA DENTAL
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 3635 OLD COURT RD STE. 510
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City | PIKESVILLE
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State | MD
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Zip | 21208-3915
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Country | US
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Telephone | 410-484-2717
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Fax | 443-519-4078
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Provider Business Mailing Address
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Address Line | 3635 OLD COURT RD STE. 510
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City | PIKESVILLE
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State | MD
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Zip | 21208-3915
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Country | US
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Telephone |
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Fax | 443-519-4078
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LARRY BANK
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Credential | DDS
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Telephone | 410-484-2717
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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 | 4961
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License Number State | MD
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