Healthcare Provider Details

I. General information

NPI: 1992138697
Provider Name (Legal Business Name): BETHESDA CHEVY CHASE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 WISCONSIN AVE P101
CHEVY CHASE MD
20815-6122
US

IV. Provider business mailing address

6831 WISCONSIN AVE P101
CHEVY CHASE MD
20815-6122
US

V. Phone/Fax

Practice location:
  • Phone: 301-986-8777
  • Fax: 301-986-8873
Mailing address:
  • Phone: 301-986-8777
  • Fax: 301-986-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. BEN MANESH
Title or Position: OWNER / OPERATOR
Credential:
Phone: 301-986-8777