NPIMap

Organization Active NPI

Divine Dental LLC

Doing business as Brooklyn Park Dental Center

  • General Practice Dentistry
  • Baltimore, MD
National Provider Identifier
1710299268
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7069 Issued in MD
Legal business name
DIVINE DENTAL LLC
Doing business as
Brooklyn Park Dental Center
Practice address
4801 Ritchie Hwy
Baltimore, MD 21225-3045
Phone
(410) 789-5228
Fax
(410) 789-2162
NPI assigned
Jul 12, 2010
Organization subpart
Yes
Parent organization
DIVINE DENTAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Maryellen Desrochers
Title
Office Manager
Phone
(410) 789-5228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7069 MD Primary

Addresses

Primary practice location

4801 Ritchie Hwy
Baltimore, MD 21225-3045

Mailing address

4801 Ritchie Hwy
Baltimore, MD 21225-3045
Phone (410) 789-5228

Other names 1

  • Brooklyn Park Dental Center Doing business as

National Provider Directory

National Provider Directory
Part of
Divine Dental LLC

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1710299268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 RITCHIE HWY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212253045",
            "telephone_number": "410-789-5228",
            "fax_number": "410-789-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 RITCHIE HWY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212253045",
            "telephone_number": "410-789-5228",
            "fax_number": "410-789-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVINE DENTAL LLC",
        "enumeration_date": "2010-07-12",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "DESROCHERS",
        "authorized_official_first_name": "MARYELLEN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "410-789-5228"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "7069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brooklyn Park Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 14, 2023; 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.