Provider Demographics
NPI:1760753420
Name:CATHY WILTSHIRE DDS PA
Entity Type:Organization
Organization Name:CATHY WILTSHIRE DDS PA
Other - Org Name:STRAIGHTEN UP ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILTSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-879-1607
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5202
Mailing Address - Country:US
Mailing Address - Phone:301-879-1607
Mailing Address - Fax:301-879-1637
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 307
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5202
Practice Address - Country:US
Practice Address - Phone:301-879-1607
Practice Address - Fax:301-879-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9199772Medicaid