Provider Demographics
NPI:1235142837
Name:O W JOHN & ASSC
Entity Type:Organization
Organization Name:O W JOHN & ASSC
Other - Org Name:METRO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LEATRICE
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-870-3966
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:6620 CRAIN HWY STE 204
Mailing Address - City:LA PLATA
Mailing Address - State:MO
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:301-870-3966
Mailing Address - Fax:301-753-1992
Practice Address - Street 1:6620 CRAIN HWY
Practice Address - Street 2:STE 204
Practice Address - City:LA PLATA
Practice Address - State:MO
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-870-3966
Practice Address - Fax:301-753-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty