| Shady Grove Modern Dental Pc | |
|
9051 Shady Grove Court Gaithersburg MD 20877 | |
| (301) 330-4613 | |
| (301) 330-4619 |
| Full Name | Shady Grove Modern Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 9051 Shady Grove Court, Gaithersburg, Maryland |
| Authorized Official Name and Position | Duy Tam Tran Kiem (PRESIDENT) |
| Authorized Official Contact | 3013304613 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shady Grove Modern Dental Pc 9051 Shady Grove Court Gaithersburg MD 20877 Ph: (301) 330-4613 | Shady Grove Modern Dental Pc 9051 Shady Grove Court Gaithersburg MD 20877 Ph: (301) 330-4613 |
| NPI Number | 1508802414 |
|---|---|
| Provider Enumeration Date | 06/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508802414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 11662 (Maryland) | Primary |
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