Healthcare Provider Details

I. General information

NPI: 1871806521
Provider Name (Legal Business Name): CUNPING QIU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 SARVIS AVE STE 600
RIVERDALE MD
20737-1355
US

IV. Provider business mailing address

310 W EDMONSTON DR
ROCKVILLE MD
20852-1221
US

V. Phone/Fax

Practice location:
  • Phone: 301-864-7006
  • Fax: 301-864-7210
Mailing address:
  • Phone: 240-938-4093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14572
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: