Spa Creek Dental of MD LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SPA CREEK DENTAL OF MD LLC

Practice address

185 Admiral Cochrane Dr
Suite 117
Annapolis, MD 21401-7493

Phone

(757) 330-0766

NPI assigned

Apr 20, 2017

Organization subpart

No

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

Authorized official

Name

Keith Dunoff, DMD

Title

Sole Member

Phone

(757) 330-0766

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1922533579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 ADMIRAL COCHRANE DR",
            "address_2": "SUITE 117",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017493",
            "telephone_number": "757-330-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 ADMIRAL COCHRANE DR",
            "address_2": "SUITE 117",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017493",
            "telephone_number": "757-330-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA CREEK DENTAL OF MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "DUNOFF",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "757-330-0766",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  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 20, 2017; 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.