Provider Demographics
NPI:1164756938
Name:SPECIAL CARE DENTISTRY
Entity Type:Organization
Organization Name:SPECIAL CARE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY-NEITHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-735-3006
Mailing Address - Street 1:PO BOX 6078
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20791-6078
Mailing Address - Country:US
Mailing Address - Phone:301-735-3006
Mailing Address - Fax:
Practice Address - Street 1:5001 SILVER HILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-5215
Practice Address - Country:US
Practice Address - Phone:301-735-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty