Provider Demographics
NPI:1598930729
Name:UNIVERSITY CENTRE DENTAL ASSOC. P.C.
Entity Type:Organization
Organization Name:UNIVERSITY CENTRE DENTAL ASSOC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-220-1900
Mailing Address - Street 1:7833 WALKER DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3211
Mailing Address - Country:US
Mailing Address - Phone:301-220-1900
Mailing Address - Fax:301-474-0433
Practice Address - Street 1:7833 WALKER DR
Practice Address - Street 2:SUITE 10
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3211
Practice Address - Country:US
Practice Address - Phone:301-220-1900
Practice Address - Fax:301-474-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty