Healthcare Provider Details

I. General information

NPI: 1811060734
Provider Name (Legal Business Name): BEHRENS & KISHTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11404 OLD GEORGETOWN ROAD SUITE 104
ROCKVILLE MD
20852
US

IV. Provider business mailing address

11404 OLD GEORGETOWN ROAD SUITE 104
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-984-9111
  • Fax: 301-984-0374
Mailing address:
  • Phone: 301-984-9111
  • Fax: 301-984-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number8776
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberD0041703
License Number StateMD

VIII. Authorized Official

Name: DR. STEVEN ROBERT KISHTER
Title or Position: PRESIDENT
Credential: MD DDS
Phone: 301-984-9111