NPIMap

Organization Active NPI

Highlandtown Dental Group, LLC

  • Dentist
  • Baltimore, MD
National Provider Identifier
1255948048
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
HIGHLANDTOWN DENTAL GROUP, LLC
Practice address
3715 Eastern Ave
Baltimore, MD 21224-4208
Phone
(410) 327-5488
NPI assigned
Sep 25, 2020
Last updated
Sep 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vladimir Semerey
Title
Manager
Phone
(410) 685-0002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

3715 Eastern Ave
Baltimore, MD 21224-4208

Mailing address

3715 Eastern Ave
Baltimore, MD 21224-4208
Phone (410) 327-5488

Other identifiers 1

IdentifierTypeStateIssuer
111047100MedicaidMD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1255948048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212244208",
            "telephone_number": "410-327-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212244208",
            "telephone_number": "410-327-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLANDTOWN DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "SEMEREY",
        "authorized_official_first_name": "VLADIMIR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "410-685-0002"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111047100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.