Provider Demographics
NPI:1689118911
Name:MARYLAND FAMILY AND GENERAL DENTISTRY, L.L.C
Entity Type:Organization
Organization Name:MARYLAND FAMILY AND GENERAL DENTISTRY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOORITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOORITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-598-3910
Mailing Address - Street 1:13975 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2921
Mailing Address - Country:US
Mailing Address - Phone:301-598-3910
Mailing Address - Fax:301-603-0861
Practice Address - Street 1:13975 CONNECTICUT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-598-3910
Practice Address - Fax:301-603-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty