Provider Demographics
NPI:1366795312
Name:DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1708 JOAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3717
Mailing Address - Country:US
Mailing Address - Phone:410-668-7171
Mailing Address - Fax:410-668-7172
Practice Address - Street 1:1708 JOAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3717
Practice Address - Country:US
Practice Address - Phone:410-668-7171
Practice Address - Fax:410-668-7172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTLA CARE OF MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-16
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty