MEDICARE: OLYMPUS DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223P0221X	Pediatric Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114344843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPUS DENTAL LLC

Provider Business Mailing Address
First Line	:	19231 MONTGOMERY VILLAGE AVE
Second Line	:	SUITE D12
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-5023
Country	:	US
Telephone Number	:	240-780-7002
Fax Number	:	240-780-7022

Provider Business Practice Location Address
First Line	:	19231 MONTGOMERY VILLAGE AVE
Second Line	:	SUITE D12
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-5023
Country	:	US
Telephone Number	:	240-780-7002
Fax Number	:	240-780-7022

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. NAVEEN KWATRA
Credential	:	DDS
Telephone Number	:	240-780-7002

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	10/06/2014

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Directions to “OLYMPUS DENTAL LLC ” Practice Location

Language	Start Address	Practice Location

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