Provider Demographics
NPI:1619590668
Name:GAITHERSBURG ORTHO LLC
Entity Type:Organization
Organization Name:GAITHERSBURG ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:443-910-6426
Mailing Address - Street 1:814 W DIAMOND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1448
Mailing Address - Country:US
Mailing Address - Phone:301-948-7660
Mailing Address - Fax:
Practice Address - Street 1:814 W DIAMOND AVE STE 300
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1448
Practice Address - Country:US
Practice Address - Phone:301-948-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty