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General NPI Number Information
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NPI Number | 1003909011
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Entity Type | Organization
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Legal Business Name | THE DENTAL GROUP OF FORT WASHINGTON
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6710 OXON HILL RD SUITE #350
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City | OXON HILL
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State | MD
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Zip | 20745-1121
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Country | US
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Telephone | 301-248-3810
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Fax | 301-449-6746
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Provider Business Mailing Address
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Address Line | 2203 PARKSIDE DR
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-4228
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Country | US
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Telephone | 301-390-2575
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANA C. JACKSON
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Credential | DDS
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Telephone | 301-248-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN4466
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9883
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License Number State | MD
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