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General NPI Number Information
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NPI Number | 1306027784
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Entity Type | Organization
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Legal Business Name | KENTLANDS DENTAL AND ORHODONTIC GROUP INC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 308 MAIN ST
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5518
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Country | US
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Telephone | 301-977-9787
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Fax | 301-977-0680
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Provider Business Mailing Address
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Address Line | 308 MAIN ST
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5518
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Country | US
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Telephone | 301-977-9787
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Fax | 301-977-0680
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Authorized Official
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Title or Position | OWNER
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Name | DR. AKRAM HASSAN SHOUHAYIB
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Credential | DDS-MS
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Telephone | 301-977-9787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10178
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10178
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10178
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License Number State | MD
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