Healthcare Provider Details

I. General information

NPI: 1710848684
Provider Name (Legal Business Name): ANDREW TONG DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 RUSSELL AVE STE 200
GAITHERSBURG MD
20879-3282
US

IV. Provider business mailing address

903 RUSSELL AVE STE 200
GAITHERSBURG MD
20879-3282
US

V. Phone/Fax

Practice location:
  • Phone: 301-216-1780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
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

VIII. Authorized Official

Name: DR. ANDREW TONG
Title or Position: PERIODONTIST
Credential: DDS, MS
Phone: 301-943-6279