Provider Demographics
NPI: | 1164202784 |
---|---|
Name: | MONTGOMERY COUNTY MARYLAND GOVERNMENT |
Entity Type: | Organization |
Organization Name: | MONTGOMERY COUNTY MARYLAND GOVERNMENT |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JAMEELAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | JM-HL, MPH, MBA-HCM |
Authorized Official - Phone: | 571-320-0150 |
Mailing Address - Street 1: | 401 HUNGERFORD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20850-4154 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 240-777-4520 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 705 BAYFIELD ST (DENTAL) |
Practice Address - Street 2: | |
Practice Address - City: | TAKOMA PARK |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20912 |
Practice Address - Country: | US |
Practice Address - Phone: | 240-740-1950 |
Practice Address - Fax: | 301-431-7643 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MONTGOMERY COUNTY MARYLAND GOVERNMENT |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-10-02 |
Last Update Date: | 2023-10-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |