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General NPI Number Information
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NPI Number | 1568095735
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN OF MARYLAND 2 LLC
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 9812 FALLS RD
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City | POTOMAC
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State | MD
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Zip | 20854-3976
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Country | US
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Telephone | 301-983-9804
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 SPRING ST NW STE 600
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City | ATLANTA
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State | GA
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Zip | 30309-2870
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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 | CREDENTIALING SPECIALIST
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Name | MONICA PERKINS
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Credential |
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Telephone | 770-692-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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