MEDICARE: DR. CHRISTINA M DUARTE D.D.S

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	12284	MD

General Provider Information

NPI Number	:	1528130887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA M DUARTE D.D.S

Provider Business Mailing Address
First Line	:	1667 CROFTON CTR
Second Line	:	SUITE 3
City	:	CROFTON
State	:	MD
Zip	:	21114-1303
Country	:	US
Telephone Number	:	410-451-4780
Fax Number	:	410-451-4245

Provider Business Practice Location Address
First Line	:	1667 CROFTON CTR
Second Line	:	SUITE 3
City	:	CROFTON
State	:	MD
Zip	:	21114-1303
Country	:	US
Telephone Number	:	410-451-4780
Fax Number	:	410-451-4245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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