Provider Demographics
NPI:1740447838
Name:ADVANCE DENTAL CARE, INC.
Entity type:Organization
Organization Name:ADVANCE DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICCARDO
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-474-6392
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0393
Mailing Address - Country:US
Mailing Address - Phone:301-474-6392
Mailing Address - Fax:301-474-9166
Practice Address - Street 1:7259 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3613
Practice Address - Country:US
Practice Address - Phone:301-474-6392
Practice Address - Fax:301-474-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty