Provider Demographics
NPI:1124892344
Name:PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAMBELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-257-7676
Mailing Address - Street 1:23140 MOAKLEY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2923
Mailing Address - Country:US
Mailing Address - Phone:301-997-1800
Mailing Address - Fax:301-997-0402
Practice Address - Street 1:23140 MOAKLEY ST STE 3
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2923
Practice Address - Country:US
Practice Address - Phone:301-997-1800
Practice Address - Fax:301-997-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty