Provider Demographics
NPI:1497994461
Name:ROCKVILLE PEDIATRIC DENTAL LLC
Entity Type:Organization
Organization Name:ROCKVILLE PEDIATRIC DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:YING-ZHE
Authorized Official - Last Name:HORNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-881-0220
Mailing Address - Street 1:121 CONGRESSIONAL LANE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1542
Mailing Address - Country:US
Mailing Address - Phone:301-881-0220
Mailing Address - Fax:301-881-7546
Practice Address - Street 1:121 CONGRESSIONAL LANE
Practice Address - Street 2:SUITE 500
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-881-0220
Practice Address - Fax:301-881-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130161223P0221X
MD140441223P0221X
MD130151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty