MARLBOROUGH VILLAGE PEDIATRIC DENTAL (NPI# 1710473731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710473731 |
| Entity Type | Organization |
| Organization Name | MARLBOROUGH VILLAGE PEDIATRIC DENTAL |
| Practice Address |
5098 Brown Station Rd Ste 260 Upper Marlboro MD 20772-9124 |
| Mailing Address |
14300 Ridge View Ln Laurel MD 20707-6278 |
| Practice Telephone | 2403263738 |
| Mailing Telephone | 4432800968 |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-07-02 |
| Authorized Official Name | DR. ADRIAN JOHNSTON WILSON (OWNER/DENTIST) |
| Authorized Official Telephone | 4432800968 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
14704 | MD | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 71150100 | 05 |
| Street Address |
5098 BROWN STATION RD STE 260 |
| City | UPPER MARLBORO |
| State | MD |
| Zip Code | 20772-9124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355077 | Doris Lynn Perkins | Pharmacist | 5700 Southeast Crain Hwy, Upper Marlboro, MD 20772 | 2020-10-31 |
| 1730790221 | Creative Mind Therapy | Community/Behavioral Health | 12419 Dorsey Ln, Upper Marlboro, MD 20772 | 2020-08-10 |
| 1932727369 | Shaquitta Morton | Behavior Technician | 9440 Marlboro Pike 100, Upper Marlboro, MD 20772 | 2020-07-13 |
| 1760022958 | Keri Daniel | Nurse Practitioner | 9723 Frank Tippett Rd, Upper Marlboro, MD 20772 | 2020-01-15 |
| 1932668134 | Dentistry for Children of Maryland, LLC | Clinic/Center | 9616 Marlboro Pike, Upper Marlboro, MD 20772 | 2019-03-18 |
| 1033673918 | Shonte Renee Drakeford | Nurse Practitioner | 6610 Woodyard Road, Upper Marlboro, MD 20772 | 2019-01-25 |
| 1902391261 | Myenne Hanson | Home Health Aide | 5002 Ashford Dr, Upper Marlboro, MD 20772 | 2018-06-28 |
| 1659884849 | Clement Okehie | Home Health Aide | 13939 Bishops Bequest Rd, Upper Marlboro, MD 20772 | 2017-11-09 |
| 1497264766 | Fatu Barrie | Technician | 11112 Cranfod Drive, Upper Marlboro, MD 20772 | 2017-09-29 |
| 1801315080 | Hope Academy & Nursing Services | Nursing Care | 14101 Christian Street, Upper Marlboro, MD 20772 | 2017-09-19 |
| Find all providers in zip 20772 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295385698 | Just 4 Kidz Dentistry, LLC | Dentist | 12250 Rockville Pike Ste 200, Rockville, MD 20852-1669 | 2019-09-17 |
| 1033761960 | Caroline Larosiliere Dds and Associates | Dentist | 10605 Greenbelt Rd, Lanham, MD 20706-2274 | 2019-07-11 |
| 1720562507 | Arundel Pediatric Dental Care | Dentist | 8531 Veterans Hwy Ste 103, Millersville, MD 21108-2653 | 2018-09-18 |
| 1083192884 | Chang & Phan Dental, LLC | Dentist | 451 Hungerford Dr Ste 100, Rockville, MD 20850-5102 | 2018-08-02 |
| 1184116618 | Kiddie Cavity Care Thmd, LLC | Dentist | 3743 Branch Ave Ste A, Temple Hills, MD 20748-1408 | 2018-05-31 |
| 1851881999 | Haider Alshami | Dentist | 650 W Baltimore St, Baltimore, Md 21201, 3rd Flood, Baltimore, MD 21286 | 2018-05-15 |
| 1306335468 | Adam Elrafei | Dentist | 2 Hamill Rd Ste 266, Baltimore, MD 21210-1894 | 2018-05-04 |
| 1285121137 | Zamora Kids Dentistry, P.a. | Dentist | 1350 Blair Dr Ste I, Odenton, MD 21113-1333 | 2018-04-17 |
| 1336659721 | Tyson Bross Dmd Phd LLC | Dentist | 129 Lubrano Dr Ste 300, Annapolis, MD 21401-7568 | 2017-10-11 |
| 1548788730 | East Point Pediatric Dental Associates | Dentist | 1001 N Point Blvd Ste 503, Baltimore, MD 21224-3413 | 2017-09-07 |
| Find all providers with the same taxonomy | ||||
| City | UPPER MARLBORO |
| Zip Code | 20772 |
Please comment or provide details below to improve the information on MARLBOROUGH VILLAGE PEDIATRIC DENTAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.