Healthcare Provider Details

I. General information

NPI: 1356158463
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF GERMANTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20300 SENECA MEADOWS PKWY STE 100
GERMANTOWN MD
20876-7010
US

IV. Provider business mailing address

20300 SENECA MEADOWS PKWY STE 100
GERMANTOWN MD
20876-7010
US

V. Phone/Fax

Practice location:
  • Phone: 301-820-7158
  • Fax: 240-477-5814
Mailing address:
  • Phone: 301-820-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: IFEANYI ALEX OKOYE
Title or Position: DENTIST/OWNER
Credential:
Phone: 281-857-5514