Healthcare Provider Details

I. General information

NPI: 1336338227
Provider Name (Legal Business Name): YEKATERINA MAMCHUR DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MONROE PLACE SUITE 607
ROCKVILLE MD
20850
US

IV. Provider business mailing address

51 MONROE PLACE SUITE 607
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-3460
  • Fax: 301-762-3461
Mailing address:
  • Phone: 301-762-3460
  • Fax: 301-762-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13257
License Number StateMD

VIII. Authorized Official

Name: YEKATERINA MAMCHUR
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-762-3460