Provider Demographics
NPI:1609491679
Name:PEDIATRIC DENTISTRY OF MARYLAND, LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOJUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-227-3198
Mailing Address - Street 1:5828 WHITE PEBBLE PATH
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1664
Mailing Address - Country:US
Mailing Address - Phone:607-227-3198
Mailing Address - Fax:
Practice Address - Street 1:4595 VAN BUREN ST STE 230
Practice Address - Street 2:
Practice Address - City:RIVERDALE PARK
Practice Address - State:MD
Practice Address - Zip Code:20737-1080
Practice Address - Country:US
Practice Address - Phone:607-227-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty