MEDICARE: DYNAMIC DENTAL CARE, 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	122300000X	Dentist	13269	MD

General Provider Information

NPI Number	:	1922458769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	5410 LYNX LN
Second Line	:	SUITE 290
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2376
Country	:	US
Telephone Number	:	410-910-9716
Fax Number	:	301-879-5430

Provider Business Practice Location Address
First Line	:	5410 LYNX LN
Second Line	:	SUITE 290
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2376
Country	:	US
Telephone Number	:	410-910-9716
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	:	06/13/2016
Last Update Date	:	06/13/2016

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