Provider Demographics
NPI:1396058434
Name:KEY WEST CROSSING DENTAL ASSOCIATES
Entity type:Organization
Organization Name:KEY WEST CROSSING DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-738-2111
Mailing Address - Street 1:15020 SHADY GROVE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3364
Mailing Address - Country:US
Mailing Address - Phone:301-738-2111
Mailing Address - Fax:301-738-6438
Practice Address - Street 1:15020 SHADY GROVE RD
Practice Address - Street 2:SUITE 325
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3364
Practice Address - Country:US
Practice Address - Phone:301-738-2111
Practice Address - Fax:301-738-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10599122300000X
MD14243122300000X
MD134941223P0300X
MD8171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty