Provider Demographics
NPI:1285250498
Name:PEDIATRIC DENTISTRY AT NORTH BETHESDA
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY AT NORTH BETHESDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANABE YAAGISHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:240-669-8647
Mailing Address - Street 1:6001 MONTROSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4872
Mailing Address - Country:US
Mailing Address - Phone:240-669-8647
Mailing Address - Fax:
Practice Address - Street 1:6001 MONTROSE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4872
Practice Address - Country:US
Practice Address - Phone:240-669-8647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty