| NPI | 1487397873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN DANIEL BELLAMY CEO 410-735-5265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2024-10-17 |