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General NPI Number Information
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NPI Number | 1215423215
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Entity Type | Organization
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Legal Business Name | ELITE ROOT CANAL SPECIALTIES
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 7525 GREENWAY CENTER DR STE T6
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City | GREENBELT
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State | MD
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Zip | 20770-3527
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Country | US
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Telephone | 240-219-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 134 PERTH AMBOY CT
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-1162
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. VALERIE IJEOMA OKEHIE
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Credential | DDS, MS
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Telephone | 240-219-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 14450
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License Number State | MD
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