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General NPI Number Information
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NPI Number | 1902072408
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Entity Type | Organization
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Legal Business Name | CHA-CAMP DENTAL LLC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 20036 GOSHEN RD
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City | GAITHERSBURG
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State | MD
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Zip | 20879-1604
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Country | US
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Telephone | 240-683-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 20036 GOSHEN RD
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City | GAITHERSBURG
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State | MD
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Zip | 20879-1604
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Country | US
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Telephone | 240-683-6009
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARMAINE THERESA CHA-CAMP
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Credential | D.D.S.
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Telephone | 301-537-6192
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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 | 13607
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License Number State | MD
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