| Jessup Dental Associates T/a Blank Rivera Pa | |
|
8182 Lark Brown Rd Suite 101 Elkridge MD 21075-6420 | |
| (410) 799-2692 | |
| (410) 799-3931 |
| Full Name | Jessup Dental Associates T/a Blank Rivera Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8182 Lark Brown Rd, Elkridge, Maryland |
| Authorized Official Name and Position | Emilio Enrique Rivera (PRESIDENT) |
| Authorized Official Contact | 4107992692 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessup Dental Associates T/a Blank Rivera Pa 8182 Lark Brown Rd Suite 101 Elkridge MD 21075-6420 Ph: (410) 799-2692 | Jessup Dental Associates T/a Blank Rivera Pa 8182 Lark Brown Rd Suite 101 Elkridge MD 21075-6420 Ph: (410) 799-2692 |
| NPI Number | 1154374676 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154374676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 7902 (Maryland) | Primary |
| 1223G0001X | Dentist - General Practice | 8363 (Maryland) | Secondary |
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