Provider Demographics
NPI:1922826676
Name:SPECIALTY DENTISTRY AT GAITHERSBURG
Entity type:Organization
Organization Name:SPECIALTY DENTISTRY AT GAITHERSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEG
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTAIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-869-1441
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3574
Mailing Address - Country:US
Mailing Address - Phone:301-869-1441
Mailing Address - Fax:
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 300
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3574
Practice Address - Country:US
Practice Address - Phone:301-869-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty