Provider Demographics
NPI:1235939018
Name:MAIDEN CHOICE FAMILY DENTAL LLC
Entity type:Organization
Organization Name:MAIDEN CHOICE FAMILY DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-851-3060
Mailing Address - Street 1:4660 WILKENS AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4845
Mailing Address - Country:US
Mailing Address - Phone:443-851-3060
Mailing Address - Fax:443-297-8908
Practice Address - Street 1:4660 WILKENS AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4845
Practice Address - Country:US
Practice Address - Phone:410-247-4728
Practice Address - Fax:443-297-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty