Provider Demographics
NPI:1902571698
Name:DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.
Other - Org Name:DENTISTRY AT HAGERSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:1329 PENNSYLVANIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1329 PENNSYLVANIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3110
Practice Address - Country:US
Practice Address - Phone:301-791-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty