| NPI | 1164202784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMEELAH JOHNSON Manager 240-733-1121 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-05-10 |