Provider Demographics
NPI:1770464588
Name:DENTAL CENTER GROUP INC
Entity type:Organization
Organization Name:DENTAL CENTER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-685-1008
Mailing Address - Street 1:2005 FLEET ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3026
Mailing Address - Country:US
Mailing Address - Phone:410-685-1008
Mailing Address - Fax:443-327-4573
Practice Address - Street 1:2005 FLEET ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3026
Practice Address - Country:US
Practice Address - Phone:410-685-1008
Practice Address - Fax:443-327-4573
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL CENTER GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty