Healthcare Provider Details

I. General information

NPI: 1639268832
Provider Name (Legal Business Name): SHAILJA DHIR ENSOR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 PARKLAWN DR STE 101
ROCKVILLE MD
20852-2528
US

IV. Provider business mailing address

11810 PARKLAWN DR STE 101
ROCKVILLE MD
20852-2528
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-6170
  • Fax:
Mailing address:
  • Phone: 301-881-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9900
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: