Healthcare Provider Details

I. General information

NPI: 1366203051
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHINGTON GROVE ES DENTAL CLINIC 8712 OAKMONT ST
GAITHERSBURG MD
20877
US

IV. Provider business mailing address

401 HUNGERFORD DR FL 6
ROCKVILLE MD
20850-4154
US

V. Phone/Fax

Practice location:
  • Phone: 240-740-0300
  • Fax: 301-840-4523
Mailing address:
  • Phone: 240-777-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMEELAH JOHNSON
Title or Position: MANAGER
Credential:
Phone: 240-733-1121