| Hyattsville Pediatrice Dentistry | |
|
2970 Belcrest Center Drive Suite 105 Hyattsville MD 20782-1987 | |
| (240) 764-5510 | |
| (240) 764-5512 |
| Full Name | Hyattsville Pediatrice Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2970 Belcrest Center Drive, Hyattsville, Maryland |
| Authorized Official Name and Position | Kesnel Dufresne (OWNER) |
| Authorized Official Contact | 2407645510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hyattsville Pediatrice Dentistry 2970 Belcrest Center Dr Suite 105 Hyattsville MD 20782-1987 Ph: (240) 764-5510 | Hyattsville Pediatrice Dentistry 2970 Belcrest Center Drive Suite 105 Hyattsville MD 20782-1987 Ph: (240) 764-5510 |
| NPI Number | 1760887970 |
|---|---|
| Provider Enumeration Date | 10/30/2014 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760887970 | NPI | - | NPPES |
| 14445 | Other | MD | STATE OF MARYLAND, DEPARTMENT OF HEALTH AND MENTAL HYGIENE, LICENSE |
| 410995300 | Medicaid | MD | |
| D72767 | Other | MD | DEPARTMENT OF HEALTH AND MENTAL HYGIENE, DIVISION OF DRUG CONTROL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 09236 (Maryland) | Primary |
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