1942202692 NPI number — KERNAN DENTISTRY

Table of content: (NPI 1942202692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942202692 NPI number — KERNAN DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERNAN DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942202692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 KERNAN DR
Provider Second Line Business Practice Location Address:
DENTAL SUITE T500
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21207-6665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-448-6290
Provider Business Practice Location Address Fax Number:
410-448-6883
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOGIN
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
410-448-6289

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9282-1 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S165 . This is a "DENTAL NETWORK ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 105664 . This is a "DORAL DENTAL LOCATION ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 164252 . This is a "DORAL DENTAL PAYOR ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 800194400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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