Healthcare Provider Details

I. General information

NPI: 1962365288
Provider Name (Legal Business Name): SILVERSPOON DENTAL AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 KEMMERTON LN
BOWIE MD
20715-2721
US

IV. Provider business mailing address

12300 KEMMERTON LN
BOWIE MD
20715-2721
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-1888
  • Fax: 301-262-1899
Mailing address:
  • Phone: 301-262-1888
  • Fax: 301-262-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. TYRUS G MONTGOMERY
Title or Position: DENTIST
Credential: DMD
Phone: 301-266-1888