Provider Demographics
NPI:1649700089
Name:FLORENTINO, NGOCBICH LAM (DDS)
Entity type:Individual
Prefix:
First Name:NGOCBICH
Middle Name:LAM
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 DEBORAH JEAN DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-1001
Mailing Address - Country:US
Mailing Address - Phone:719-229-0913
Mailing Address - Fax:
Practice Address - Street 1:5877 DEBORAH JEAN DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-1001
Practice Address - Country:US
Practice Address - Phone:719-229-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002031901223G0001X
MD176101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice