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General NPI Number Information
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NPI Number | 1053079830
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Entity Type | Organization
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Legal Business Name | ADVANCED COSMETIC AND GENERAL DENTISTRY GROUP, PC
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 1090 VERMONT AVE NW STE 106
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City | WASHINGTON
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State | DC
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Zip | 20005-4905
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Country | US
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Telephone | 202-798-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 18119 CASHELL RD
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City | OLNEY
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State | MD
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Zip | 20832-2003
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Country | US
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Telephone | 617-699-5557
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ANDREA HARDTER
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Credential |
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Telephone | 617-699-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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