MEDICARE: JESSUP DENTAL ASSOCIATES T/A BLANK RIVERA PA

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	1223G0001X	General Practice Dentistry	8363	MD
2	1223G0001X	General Practice Dentistry	7902	MD

General Provider Information

NPI Number	:	1154374676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSUP DENTAL ASSOCIATES T/A BLANK RIVERA PA

Provider Business Mailing Address
First Line	:	8182 LARK BROWN RD
Second Line	:	SUITE 101
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6420
Country	:	US
Telephone Number	:	410-799-2692
Fax Number	:	410-799-3931

Provider Business Practice Location Address
First Line	:	8182 LARK BROWN RD
Second Line	:	SUITE 101
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6420
Country	:	US
Telephone Number	:	410-799-2692
Fax Number	:	410-799-3931

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EMILIO ENRIQUE RIVERA
Credential	:	DDS
Telephone Number	:	410-799-2692

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1568466084 — MS. RENEE JUNE MERCER MSN, CPNP
Practice Location Address:

8186 LARK BROWN RD , STE 202
ELKRIDGE, MD
21075-6420

Practice Phone: 301-774-1349
Practice Fax: 301-774-7982

1891780169 — DR. JUNE MARIE GOSE PHARM.D.
Practice Location Address:

8186 LARK BROWN RD , SUITE 101
ELKRIDGE, MD
21075-6420

Practice Phone: 443-620-9990
Practice Fax: 443-620-9993

1922076405 — DR. GARY ALAN MILLES M.D.
Practice Location Address:

8186 LARK BROWN RD , SUITE 203
ELKRIDGE, MD
21075-6420

Practice Phone: 410-799-8860
Practice Fax: 410-616-8668

1376503243 — DORSEY HALL MEDICAL LABORATORY, LLC
Practice Location Address:

8186 LARK BROWN RD , SUITE 103
ELKRIDGE, MD
21075-6420

Practice Phone: 410-799-8100
Practice Fax: 410-799-0069

1861439929 — ROWER CHIROPRACTIC LLC
Practice Location Address:

8182 LARK BROWN RD , SUITE 102
ELKRIDGE, MD
21075-6420

Practice Phone: 410-799-7550
Practice Fax: 410-799-7554

1598315822 — JACK HOFMEISTER
Practice Location Address:

6420 IVY TER
ELKRIDGE, MD
21075-5831

Practice Phone: 410-865-9376
Practice Fax:

Directions to “JESSUP DENTAL ASSOCIATES T/A BLANK RIVERA PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.