MEDICARE: NORTH BAY FAMILY 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	1223G0001X	General Practice Dentistry	13880	MD

General Provider Information

NPI Number	:	1457748121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BAY FAMILY DENTAL

Provider Business Mailing Address
First Line	:	3135 JOSEPH BIGGS MEMORIAL HWY
Second Line	:	SUITE 2B
City	:	NORTH EAST
State	:	MD
Zip	:	21901-1839
Country	:	US
Telephone Number	:	410-983-3000
Fax Number	:	410-567-5449

Provider Business Practice Location Address
First Line	:	3135 JOSEPH BIGGS MEMORIAL HWY
Second Line	:	SUITE 2B
City	:	NORTH EAST
State	:	MD
Zip	:	21901-1839
Country	:	US
Telephone Number	:	410-983-3000
Fax Number	:	410-567-5449

Authorized Official
Title or Position	:	RECEPTION
Name	:	MINDA BETH GATES
Credential	:
Telephone Number	:	410-983-3000

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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