Provider Demographics
NPI:1558747311
Name:GENTLE GREEN DENTAL CARE LLC
Entity Type:Organization
Organization Name:GENTLE GREEN DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREEMA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:MOHOMED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-237-8050
Mailing Address - Street 1:46400 LEXINGTON VILLAGE WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-5564
Mailing Address - Country:US
Mailing Address - Phone:240-237-8050
Mailing Address - Fax:
Practice Address - Street 1:46400 LEXINGTON VILLAGE WAY
Practice Address - Street 2:STE 101
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-5564
Practice Address - Country:US
Practice Address - Phone:240-237-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty