Healthcare Provider Details

I. General information

NPI: 1629358460
Provider Name (Legal Business Name): KINGSLEY ACHIKEH DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 GEORGIA AVE
SILVER SPRING MD
20910-3645
US

IV. Provider business mailing address

8780 GEORGIA AVE
SILVER SPRING MD
20910-3645
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-1515
  • Fax: 301-585-5206
Mailing address:
  • Phone: 301-585-1515
  • Fax: 301-585-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11956
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7058
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6265
License Number StateMD

VIII. Authorized Official

Name: DR. KINGSLEY U ACHIKEH
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-585-1515