Healthcare Provider Details

I. General information

NPI: 1265128987
Provider Name (Legal Business Name): YELENA OBHOLZ DDS IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 EXECUTIVE BLVD STE 100
NORTH BETHESDA MD
20852-3817
US

IV. Provider business mailing address

6000 EXECUTIVE BLVD STE 100
NORTH BETHESDA MD
20852-3817
US

V. Phone/Fax

Practice location:
  • Phone: 240-482-8244
  • Fax: 202-244-9609
Mailing address:
  • Phone: 240-482-8244
  • Fax: 202-244-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: YELENA OBHOLZ
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 301-318-2302