Provider Demographics
NPI:1184345563
Name:SURE DENTAL CARE LLC
Entity type:Organization
Organization Name:SURE DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRIKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BHUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-304-3380
Mailing Address - Street 1:615 W MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3815
Mailing Address - Country:US
Mailing Address - Phone:301-304-3380
Mailing Address - Fax:
Practice Address - Street 1:615 W MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3815
Practice Address - Country:US
Practice Address - Phone:301-304-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402284000Medicaid