Healthcare Provider Details

I. General information

NPI: 1962249029
Provider Name (Legal Business Name): IB DENTAL V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E WEST HWY STE G
SILVER SPRING MD
20910-3230
US

IV. Provider business mailing address

4300 MONTGOMERY AVE STE 206A
BETHESDA MD
20814-4460
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-6804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DAYSE
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-585-6804