MEDICARE: DYNAMIC DENTAL SERVICES 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376123406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC DENTAL SERVICES LLC

Provider Business Mailing Address
First Line	:	13401 NEW HAMPSHIRE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1243
Country	:	US
Telephone Number	:	301-879-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	13401 NEW HAMPSHIRE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1243
Country	:	US
Telephone Number	:	301-879-8337
Fax Number	:	301-879-5430

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. KWEKU L JANGHA
Credential	:	DDS
Telephone Number	:	301-879-8337

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/13/2021

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