Provider Demographics
NPI:1811060734
Name:BEHRENS & KISHTER PC
Entity type:Organization
Organization Name:BEHRENS & KISHTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KISHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:301-984-9111
Mailing Address - Street 1:11404 OLD GEORGETOWN ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-984-9111
Mailing Address - Fax:301-984-0374
Practice Address - Street 1:11404 OLD GEORGETOWN ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-984-9111
Practice Address - Fax:301-984-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8776204E00000X
MDD0041703204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty