Healthcare Provider Details

I. General information

NPI: 1497994461
Provider Name (Legal Business Name): ROCKVILLE PEDIATRIC DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CONGRESSIONAL LANE SUITE 500
ROCKVILLE MD
20852-1542
US

IV. Provider business mailing address

121 CONGRESSIONAL LANE SUITE 500
ROCKVILLE MD
20852-1542
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-0220
  • Fax: 301-881-7546
Mailing address:
  • Phone: 301-881-0220
  • Fax: 301-881-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14044
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number13015
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13016
License Number StateMD

VIII. Authorized Official

Name: DR. ANDREW YING-ZHE HORNG
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 301-881-0220