NPIMap

Organization Active NPI

Children's Dentistry at Odenton

  • Pediatric Dentistry
  • Odenton, MD
National Provider Identifier
1376820654
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
12374 Issued in MD
Legal business name
CHILDREN'S DENTISTRY AT ODENTON
Practice address
1215 Annapolis Rd
Suite 106
Odenton, MD 21113-1344
Phone
(410) 672-1100
Fax
(410) 672-1107
NPI assigned
Nov 14, 2011
Last updated
Nov 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Authorized official

Name
Dr. Maria Sevilla Guevara, DMD
Title
President
Phone
(410) 672-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 12374 MD Primary

Addresses

Primary practice location

1215 Annapolis Rd
Suite 106
Odenton, MD 21113-1344

Mailing address

1215 Annapolis Rd
Suite 106
Odenton, MD 21113-1344
Phone (410) 672-1100

Other identifiers 1

IdentifierTypeStateIssuer
135705100MedicaidMD

National Provider Directory

National Provider Directory

Locations

1215 Annapolis Rd
Ste 106
Odenton, MD 21113
Phone (410) 672-1100

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1376820654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 ANNAPOLIS RD",
            "address_2": "SUITE 106",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131344",
            "telephone_number": "410-672-1100",
            "fax_number": "410-672-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 ANNAPOLIS RD",
            "address_2": "SUITE 106",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131344",
            "telephone_number": "410-672-1100",
            "fax_number": "410-672-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTISTRY AT ODENTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "GUEVARA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "SEVILLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-672-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "12374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135705100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odenton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.