MEDICARE: DELICATE DENTAL OF MARYLAND, P.C.

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	MD 11133	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	819282	OTHER	MD	UNITED CONCORDIA INSURANC
2	D960	OTHER	MD	BCBS OF MD INSURANCE

General Provider Information

NPI Number	:	1386779239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELICATE DENTAL OF MARYLAND, P.C.

Provider Business Mailing Address
First Line	:	1071 MD RT 3 N
Second Line	:	SUITE 201
City	:	GAMBRILLS
State	:	MD
Zip	:	21054-1784
Country	:	US
Telephone Number	:	410-721-8777
Fax Number	:	410-721-5153

Provider Business Practice Location Address
First Line	:	1071 MD RT 3 N
Second Line	:	SUITE 201
City	:	GAMBRILLS
State	:	MD
Zip	:	21054-1784
Country	:	US
Telephone Number	:	410-721-8777
Fax Number	:	410-721-5153

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. ANTONINO BARBARO
Credential	:	DDS
Telephone Number	:	410-721-8777

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	03/14/2017

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