Provider Demographics
NPI:1710010798
Name:ELIZABETH C. ROBLES DDS LLC
Entity Type:Organization
Organization Name:ELIZABETH C. ROBLES DDS LLC
Other - Org Name:MODERN ZEN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-900-8010
Mailing Address - Street 1:19735 GERMANTOWN RD STE 230
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1217
Mailing Address - Country:US
Mailing Address - Phone:301-900-8010
Mailing Address - Fax:301-540-9223
Practice Address - Street 1:19735 GERMANTOWN RD STE 230
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1217
Practice Address - Country:US
Practice Address - Phone:301-900-8010
Practice Address - Fax:301-540-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty