Provider Demographics
NPI:1942545215
Name:EJIRO ESI DDS PC
Entity type:Organization
Organization Name:EJIRO ESI DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EJIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-245-0540
Mailing Address - Street 1:2720 S ARLINGTON MILL DR UNIT 711
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3915 NATIONAL DR
Practice Address - Street 2:150
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1126
Practice Address - Country:US
Practice Address - Phone:240-245-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty