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200 Girard St Ste 206 Gaithersburg MD 20877-3490 | |
| (240) 720-0510 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 200 Girard St Ste 206, Gaithersburg, Maryland |
| Authorized Official Name and Position | Alisa Brightley (LEAD CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2402976758 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8665 Georgia Ave Silver Spring MD 20910-3405 Ph: () - | 200 Girard St Ste 206 Gaithersburg MD 20877-3490 Ph: (240) 720-0510 |
| NPI Number | 1588480305 |
|---|---|
| Provider Enumeration Date | 11/26/2024 |
| Last Update Date | 12/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588480305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
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