NPIMap

Organization Active NPI

Spectrum Dental Services P a

  • Dentist
  • Baltimore, MD
National Provider Identifier
1669687802
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SPECTRUM DENTAL SERVICES P A
Practice address
200 East 33Rd Street
Suite 284
Baltimore, MD 21218
Phone
(410) 235-0062
NPI assigned
May 11, 2007
Last updated
Nov 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Authorized official

Name
Sheila R Turner Johnson
Title
Business Manager
Phone
(410) 541-4432

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7695 MD

Addresses

Primary practice location

200 East 33Rd Street
Suite 284
Baltimore, MD 21218

Mailing address

200 E 33Rd Street
Suite 284
Baltimore, MD 21218
Phone (410) 235-0062

Other identifiers 4

IdentifierTypeStateIssuer
0004418OtherMDDORAL DENTAL
2009OtherMDCAREFIRST BLUECROSS
000952871OtherMDUNITED CONCORDIA
261864800MedicaidMD

National Provider Directory

National Provider Directory

Locations

200 E 33rd St
Ste 284
Baltimore, MD 21218
Phone (410) 235-0062

Practitioners & affiliated clinicians

Practitioners 2

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": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1669687802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 33RD STREET",
            "address_2": "SUITE 284",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21218",
            "telephone_number": "410-235-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EAST 33RD STREET",
            "address_2": "SUITE 284",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21218",
            "telephone_number": "410-235-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM DENTAL SERVICES P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "TURNER JOHNSON",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "410-541-4432"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "7695",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL",
            "identifier": "0004418",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECROSS",
            "identifier": "2009",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "000952871",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261864800",
            "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 Nov 10, 2021; 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.