Provider Demographics
NPI:1346413556
Name:JEROME S CASPER CHILDRENS DENTAL OFFICE P.A.
Entity Type:Organization
Organization Name:JEROME S CASPER CHILDRENS DENTAL OFFICE P.A.
Other - Org Name:CHILDRENS DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-924-5500
Mailing Address - Street 1:2923 OLNEY SANDY SPRING RD STE D
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1583
Mailing Address - Country:US
Mailing Address - Phone:301-924-5500
Mailing Address - Fax:301-924-0412
Practice Address - Street 1:2923 OLNEY SANDY SPRING RD STE D
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1583
Practice Address - Country:US
Practice Address - Phone:301-924-5500
Practice Address - Fax:301-924-0412
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEROME S CASPER CHILDRENS DENTAL OFFICE P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD65151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty