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NPI Code Detail

MEDICARE: CCDC PROFESSIONALS, LLC

MEDICARE: CCDC PROFESSIONALS, 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
11223P0221XPediatric Dentistry
21223D0004XDental Anesthesiology
31223G0001XGeneral Practice Dentistry
4122300000XDentist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11023307055OTHERNPI

General Provider Information

NPI Number : 1285184218
Entity Type Code : Organization
Provider Name (Legal Business Name) : CCDC PROFESSIONALS, LLC
Provider Business Mailing Address
First Line : 1220 CARAWAY CT STE 1050
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20774-5338
Country : US
Telephone Number : 301-494-3000
Fax Number : 301-494-3333
Provider Business Practice Location Address
First Line : 1220 CARAWAY CT STE 1050
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20774-5338
Country : US
Telephone Number : 301-494-3000
Fax Number : 301-494-3333
Authorized Official
Title or Position : DIRECTOR OF FINANCE
Name : MRS. CAMILLE TAYLOR
Credential :
Telephone Number : 202-536-9366
Provider Enumeration Date : 10/13/2016
Last Update Date : 03/02/2026

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Directions to “CCDC PROFESSIONALS, LLC ” Practice Location

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