Provider Demographics
NPI:1033683024
Name:CENTER FOR ADVANCED DENTISTRY LLC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-593-4200
Mailing Address - Street 1:10301 GEORGIA AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-593-4200
Mailing Address - Fax:301-754-1614
Practice Address - Street 1:10301 GEORGIA AVE STE 307
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-593-4200
Practice Address - Fax:301-754-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental