Provider Demographics
NPI:1962665257
Name:CHILDREN & ADOLESCENT DENTISTRY
Entity Type:Organization
Organization Name:CHILDREN & ADOLESCENT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OBERTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-431-1660
Mailing Address - Street 1:831 UNIVERSITY BLVD E
Mailing Address - Street 2:SUIT 36B
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2916
Mailing Address - Country:US
Mailing Address - Phone:301-431-1660
Mailing Address - Fax:301-431-1044
Practice Address - Street 1:831 UNIVERSITY BLVD E
Practice Address - Street 2:SUIT 36B
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2916
Practice Address - Country:US
Practice Address - Phone:301-431-1660
Practice Address - Fax:301-431-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty