MEDICARE: POTOMAC PEDIATRIC DENTAL GROUP 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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1801755459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTOMAC PEDIATRIC DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	12850 MIDDLEBROOK RD STE 210
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-5244
Country	:	US
Telephone Number	:	301-881-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	12850 MIDDLEBROOK RD STE 210
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-5244
Country	:	US
Telephone Number	:	301-881-0220
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	ANDREW HORNG
Credential	:	DDS
Telephone Number	:	301-881-0220

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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