Provider Demographics
NPI:1770869968
Name:GERMANTOWN PEDIATRIC DENTAL & ORTHODONTIC CENTER, LLC
Entity type:Organization
Organization Name:GERMANTOWN PEDIATRIC DENTAL & ORTHODONTIC CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE PLANNING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-875-7408
Mailing Address - Street 1:19847 CENTURY BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7201
Mailing Address - Country:US
Mailing Address - Phone:301-916-6800
Mailing Address - Fax:
Practice Address - Street 1:19847 CENTURY BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7201
Practice Address - Country:US
Practice Address - Phone:301-916-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
MD138481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty