Provider Demographics
NPI:1851726343
Name:COMPREHENSIVE INTEGRATIVE DENTISTRY
Entity Type:Organization
Organization Name:COMPREHENSIVE INTEGRATIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-770-2270
Mailing Address - Street 1:5809 NICHOLSON LN
Mailing Address - Street 2:SUITE T123
Mailing Address - City:N BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5701
Mailing Address - Country:US
Mailing Address - Phone:301-770-2270
Mailing Address - Fax:301-468-5553
Practice Address - Street 1:5809 NICHOLSON LN
Practice Address - Street 2:SUITE T123
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-5701
Practice Address - Country:US
Practice Address - Phone:301-770-2270
Practice Address - Fax:301-468-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12906305R00000X
MD12663305R00000X
MD13707305R00000X
MD15459305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization