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General NPI Number Information
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NPI Number | 1396551909
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Entity Type | Organization
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Legal Business Name | COMMUNITY CLINIC, INC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 7615 ORA GLEN DRIVE
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City | GREENBELT
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State | MD
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Zip | 20770
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Country | US
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Telephone | 866-877-7258
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Fax |
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Provider Business Mailing Address
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Address Line | 8665 GEORGIA AVE
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City | SILVER SPRING
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State | MD
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Zip | 20910-3405
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Country | US
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Telephone | 301-340-7525
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Fax |
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Authorized Official
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Title or Position | LEAD CREDENTIALING SPECIALIST
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Name | ALISA BRIGHTLEY
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Credential |
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Telephone | 240-297-6758
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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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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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