Main Street Children's Dentistry and Orthodontics of Phoenix LLC

NPI #1043628134 in Phoenix, Maryland

Provider Information

NPI Number: 1043628134
Entity Type: Organization
Organization Name: Main Street Children's Dentistry and Orthodontics of Phoenix LLC
Primary Specialty: Dentist
Enumeration Date: Aug 1, 2014
Last Updated: Aug 1, 2014

Practice Location

Address: 3326 PAPER MILL RD
City: Phoenix
State: Maryland
ZIP Code: 21131-1419
Phone: (410) 321-8144

Authorized Official

Name: MIKE COLE
Title: VP INSURANCE PLAN MANAGEMENT
Phone: (727) 726-1611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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