Provider Demographics
NPI:1699206755
Name:CHILDREN'S DENTAL CAROUSEL INC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CAROUSEL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:ALLEN-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-449-5330
Mailing Address - Street 1:7119 ALLENTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1515
Mailing Address - Country:US
Mailing Address - Phone:301-449-5330
Mailing Address - Fax:
Practice Address - Street 1:7119 ALLENTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-1515
Practice Address - Country:US
Practice Address - Phone:301-449-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD021038200Medicaid