Provider Demographics
NPI:1871702738
Name:GLORIA MCMENAMIN DDS,DMD,PA
Entity type:Organization
Organization Name:GLORIA MCMENAMIN DDS,DMD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA ANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMENAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-339-5858
Mailing Address - Street 1:7600 OSLER DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-339-5858
Mailing Address - Fax:410-339-3838
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:SUITE 115
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-339-5858
Practice Address - Fax:410-339-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty