NPIMap

Organization Active NPI

Maxine V. Clark, D.D.S.

  • Dental Clinic/Center
  • Pasadena, MD
National Provider Identifier
1801097787
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
8300 Issued in MD
Legal business name
MAXINE V. CLARK, D.D.S.
Practice address
8028 Ritchie Hwy
Suite 202
Pasadena, MD 21122-1075
Phone
(410) 787-0075
Fax
(410) 787-0087
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Maxine Villiers Clark, D.D.S.
Title
Ceo
Phone
(410) 787-8875

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 8300 MD Primary

Addresses

Primary practice location

8028 Ritchie Hwy
Suite 202
Pasadena, MD 21122-1075

Mailing address

8028 Ritchie Hwy
Suite 202
Pasadena, MD 21122-1075
Phone (410) 787-0075

Other names 1

  • Maryland Orthodontic Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Maryland Orthodontic Specialists3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8028 Ritchie Hwy
Ste 202
Pasadena, MD 21122
Phone (410) 787-0075

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801097787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8028 RITCHIE HWY",
            "address_2": "SUITE 202",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211221075",
            "telephone_number": "410-787-0075",
            "fax_number": "410-787-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8028 RITCHIE HWY",
            "address_2": "SUITE 202",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211221075",
            "telephone_number": "410-787-0075",
            "fax_number": "410-787-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXINE V. CLARK, D.D.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MAXINE",
        "authorized_official_middle_name": "VILLIERS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-787-8875",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MD",
            "license": "8300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maryland Orthodontic Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.