Provider Demographics
NPI:1053079830
Name:ADVANCED COSMETIC AND GENERAL DENTISTRY GROUP, PC
Entity Type:Organization
Organization Name:ADVANCED COSMETIC AND GENERAL DENTISTRY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-699-5557
Mailing Address - Street 1:18119 CASHELL RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2003
Mailing Address - Country:US
Mailing Address - Phone:617-699-5557
Mailing Address - Fax:
Practice Address - Street 1:1090 VERMONT AVE NW STE 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4905
Practice Address - Country:US
Practice Address - Phone:202-798-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED COSMETIC AND GENERAL DENTISTRY GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty