Healthcare Provider Details

I. General information

NPI: 1689133043
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN OF MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OLNEY SANDY SPRING RD
ASHTON MD
20861-3656
US

IV. Provider business mailing address

2970 BRANDYWINE RD STE 200
ATLANTA GA
30341-5549
US

V. Phone/Fax

Practice location:
  • Phone: 301-924-5500
  • Fax:
Mailing address:
  • Phone: 770-692-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JO ANN RICE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 609-315-3851