Provider Demographics
NPI:1053589010
Name:KIDS DENTAL CENTER, LLC
Entity type:Organization
Organization Name:KIDS DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-740-0606
Mailing Address - Street 1:5060 DORSEY HALL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7885
Mailing Address - Country:US
Mailing Address - Phone:410-740-0606
Mailing Address - Fax:410-964-3630
Practice Address - Street 1:5060 DORSEY HALL DR STE 104
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7885
Practice Address - Country:US
Practice Address - Phone:410-740-0606
Practice Address - Fax:410-964-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13079261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental