Provider Demographics
NPI:1356564967
Name:BETHESDA DENTAL CARE LLC
Entity type:Organization
Organization Name:BETHESDA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCHUYLER
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-718-2929
Mailing Address - Street 1:4425 MONTGOMERY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4403
Mailing Address - Country:US
Mailing Address - Phone:301-718-2929
Mailing Address - Fax:301-718-8449
Practice Address - Street 1:4425 MONTGOMERY AVENUE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4403
Practice Address - Country:US
Practice Address - Phone:301-718-2929
Practice Address - Fax:301-718-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty