Provider Demographics
NPI:1952996878
Name:CHEVY CHASE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:CHEVY CHASE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-272-1246
Mailing Address - Street 1:8401 CONNECTICUT AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5839
Mailing Address - Country:US
Mailing Address - Phone:301-272-1246
Mailing Address - Fax:301-272-1248
Practice Address - Street 1:8401 CONNECTICUT AVE STE 650
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5839
Practice Address - Country:US
Practice Address - Phone:301-272-1246
Practice Address - Fax:301-272-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1588843528Medicaid