Healthcare Provider Details

I. General information

NPI: 1952239667
Provider Name (Legal Business Name): CAPITAL KIDS DENTISTRY AND ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SPRING ST STE 8788
SILVER SPRING MD
20910-3616
US

IV. Provider business mailing address

1300 SPRING ST STE 8788
SILVER SPRING MD
20910-3616
US

V. Phone/Fax

Practice location:
  • Phone: 227-229-0170
  • Fax:
Mailing address:
  • Phone: 227-229-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA WIETH
Title or Position: DIRECTOR OF PAYER RELATIONS
Credential:
Phone: 623-267-8121