Healthcare Provider Details

I. General information

NPI: 1033683024
Provider Name (Legal Business Name): CENTER FOR ADVANCED DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GEORGIA AVE STE 307
SILVER SPRING MD
20902-5020
US

IV. Provider business mailing address

10301 GEORGIA AVE STE 307
SILVER SPRING MD
20902-5020
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-4200
  • Fax: 301-754-1614
Mailing address:
  • Phone: 301-593-4200
  • Fax: 301-754-1614

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: MS. SHANNA ROSE MARK
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 301-593-4200