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General NPI Number Information
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NPI Number | 1073939310
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Entity Type | Organization
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Legal Business Name | CHILDREN DENTAL CARE, INC.
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 803 RUSSELL AVE STE 2A
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3584
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Country | US
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Telephone | 301-216-1780
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Fax | 301-258-2800
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Provider Business Mailing Address
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Address Line | 803 RUSSELL AVE STE 2A
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3584
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Country | US
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Telephone | 301-216-1780
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Fax | 301-258-2800
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JAMES TONG
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Credential | DMD
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Telephone | 301-216-1780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12363
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License Number State | MD
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