Provider Demographics
NPI:1902855422
Name:MARYLAND DENTAL LLC
Entity Type:Organization
Organization Name:MARYLAND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-869-7733
Mailing Address - Street 1:15204 OMEGA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4601
Mailing Address - Country:US
Mailing Address - Phone:301-869-7733
Mailing Address - Fax:
Practice Address - Street 1:15204 OMEGA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4601
Practice Address - Country:US
Practice Address - Phone:301-869-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty