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General NPI Number Information
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NPI Number | 1558790154
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Entity Type | Organization
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Legal Business Name | TLC MODERN DENTISTRY
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 18220 CONTOUR RD
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20877-2623
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Country | US
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Telephone | 301-208-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 18220 CONTOUR RD
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20877-2623
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Country | US
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Telephone | 301-208-0002
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ROSANN RODRIGUEZ
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Credential |
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Telephone | 301-208-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 15202
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License Number State | MD
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