Provider Demographics
NPI:1629358460
Name:KINGSLEY ACHIKEH DDS, PA
Entity Type:Organization
Organization Name:KINGSLEY ACHIKEH DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:U
Authorized Official - Last Name:ACHIKEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-585-1515
Mailing Address - Street 1:8780 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3645
Mailing Address - Country:US
Mailing Address - Phone:301-585-1515
Mailing Address - Fax:301-585-5206
Practice Address - Street 1:8780 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3645
Practice Address - Country:US
Practice Address - Phone:301-585-1515
Practice Address - Fax:301-585-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119561223G0001X
MD70581223X0400X
MD6265124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty