Provider Demographics
NPI:1225778764
Name:NATIONAL ORTHODONTIC AND PEDIATRIC DENTISTRY ASSOCIATES CORP
Entity Type:Organization
Organization Name:NATIONAL ORTHODONTIC AND PEDIATRIC DENTISTRY ASSOCIATES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROSILIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-367-8051
Mailing Address - Street 1:6200 GOLD YARROW LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4010
Mailing Address - Country:US
Mailing Address - Phone:301-367-8051
Mailing Address - Fax:
Practice Address - Street 1:3863 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1001
Practice Address - Country:US
Practice Address - Phone:301-367-8051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty