Provider Demographics
NPI:1093094476
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMEELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-733-1121
Mailing Address - Street 1:401 HUNGERFORD DR FL 6
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4154
Mailing Address - Country:US
Mailing Address - Phone:240-777-4520
Mailing Address - Fax:
Practice Address - Street 1:1335 PICCARD DR
Practice Address - Street 2:1ST FLOOR DENTAL SUITE
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4359
Practice Address - Country:US
Practice Address - Phone:240-777-1820
Practice Address - Fax:240-777-1080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-16
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420870600Medicaid