Healthcare Provider Details

I. General information

NPI: 1760360705
Provider Name (Legal Business Name): DENTOLOGIE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15729 OLD COLUMBIA PIKE
BURTONSVILLE MD
20866-1030
US

IV. Provider business mailing address

21307 DENIT ESTATES DR
BROOKEVILLE MD
20833-1837
US

V. Phone/Fax

Practice location:
  • Phone: 240-800-2000
  • Fax: 240-800-2001
Mailing address:
  • Phone: 301-661-5138
  • 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: DR. SHAMS UL ISLAM
Title or Position: OWNER
Credential: DDS
Phone: 301-661-5138