Provider Demographics
NPI:1013303403
Name:3D ORAL & MAXILLOFACIAL IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:3D ORAL & MAXILLOFACIAL IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-221-0797
Mailing Address - Street 1:11125 ROCKVILLE PIKE STE 211
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:240-221-0797
Mailing Address - Fax:
Practice Address - Street 1:11125 ROCKVILLE PIKE STE 211
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:240-221-0797
Practice Address - Fax:240-560-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14334261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental