Pdom Havre de Grace

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PDOM HAVRE DE GRACE

Practice address

2021 Pulaski Highway Units a and B
Havre de Grace, MD 21078

Phone

(410) 939-9119

NPI assigned

Jul 11, 2012

Last updated

Apr 14, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mike Cole

Title

Insurance Director

Phone

(727) 726-1611

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1396000790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 PULASKI HIGHWAY UNITS A AND B",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "21078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 PULASKI HIGHWAY UNITS A AND B",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "21078",
            "telephone_number": "410-939-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDOM HAVRE DE GRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-11",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "INSURANCE DIRECTOR",
        "authorized_official_telephone_number": "727-726-1611"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.