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General NPI Number Information
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NPI Number | 1932626801
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CHOICE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 8500 ANNAPOLIS RD STE 213
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City | NEW CARROLLTON
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State | MD
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Zip | 20784-3020
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Country | US
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Telephone | 301-731-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 ANNAPOLIS RD STE 213
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City | NEW CARROLLTON
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State | MD
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Zip | 20784-3020
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Country | US
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Telephone | 301-731-8510
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONELLE GRANT-ANAMELECHI
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Credential | DDS
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Telephone | 919-641-2676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 14623
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License Number State | MD
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