MEDICARE: BK DENTAL LLC

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	:	1093394793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BK DENTAL LLC

Provider Business Mailing Address
First Line	:	9815 MAIN ST STE 200
Second Line	:
City	:	DAMASCUS
State	:	MD
Zip	:	20872-2099
Country	:	US
Telephone Number	:	301-747-6547
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 MERCANTILE DR E STE 205
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-7657
Country	:	US
Telephone Number	:	301-747-6543
Fax Number	:	855-202-0755

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. NARAYANI K BALIGA
Credential	:	DMD
Telephone Number	:	301-747-6543

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “BK DENTAL LLC ” Practice Location

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