Provider Demographics
NPI:1306027784
Name:KENTLANDS DENTAL AND ORHODONTIC GROUP INC
Entity Type:Organization
Organization Name:KENTLANDS DENTAL AND ORHODONTIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:SHOUHAYIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS-MS
Authorized Official - Phone:301-977-9787
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5518
Mailing Address - Country:US
Mailing Address - Phone:301-977-9787
Mailing Address - Fax:301-977-0680
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5518
Practice Address - Country:US
Practice Address - Phone:301-977-9787
Practice Address - Fax:301-977-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10178122300000X, 1223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty