=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316716244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTIST AND DENTAL IMPLANTS NEAR ME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2023
-----------------------------------------------------
Last Update Date | 12/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8927 SHADY GROVE CT # 21A
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-623-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11016 NEW HAMPSHIRE AVE
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20904-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-623-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | QING XU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-623-2388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------