Healthcare Provider Details

I. General information

NPI: 1972853661
Provider Name (Legal Business Name): CHARLIE CAGE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DENTAL CORPS PROGRAMS CODE 1WPGDC 8955 WOOD RD
BESTHESDA MD
20889-5628
US

IV. Provider business mailing address

DENTAL CORPS PROGRAMS CODE 1WPGDC 8955 WOOD ROAD
BETHESDA MD
20889-5628
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0650
  • Fax:
Mailing address:
  • Phone: 301-295-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7020
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: