Healthcare Provider Details

I. General information

NPI: 1982203105
Provider Name (Legal Business Name): EZ DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 HUNGERFORD DR
ROCKVILLE MD
20850-1725
US

IV. Provider business mailing address

10000 PRESTWICH TER
IJAMSVILLE MD
21754-9601
US

V. Phone/Fax

Practice location:
  • Phone: 301-545-1666
  • Fax:
Mailing address:
  • Phone: 240-491-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEKSHA TANEJA
Title or Position: MEMBER
Credential: DMD
Phone: 240-491-2244