MEDICARE: BEAR CREEK DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1043777956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR CREEK DENTAL

Provider Business Mailing Address
First Line	:	1502 S MAIN ST STE 101
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5374
Country	:	US
Telephone Number	:	301-829-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 S MAIN ST STE 101
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5374
Country	:	US
Telephone Number	:	301-829-7300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID HUMMEL
Credential	:	DDS
Telephone Number	:	301-829-7300

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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Directions to “BEAR CREEK DENTAL ” Practice Location

Language	Start Address	Practice Location

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