Healthcare Provider Details

I. General information

NPI: 1225504533
Provider Name (Legal Business Name): WASHINGTON FAMILY DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 PISCATAWAY RD STE 410
CLINTON MD
20735-2555
US

IV. Provider business mailing address

9135 PISCATAWAY RD STE 410
CLINTON MD
20735-2555
US

V. Phone/Fax

Practice location:
  • Phone: 301-613-0735
  • Fax: 240-348-7860
Mailing address:
  • Phone: 301-613-0735
  • Fax: 240-348-7860

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: AMOS WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-348-7860