Provider Demographics
NPI:1487806360
Name:CHRISTIAN DENTAL CENTER
Entity type:Organization
Organization Name:CHRISTIAN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEARSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-702-2700
Mailing Address - Street 1:3611 BRANCH AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748
Mailing Address - Country:US
Mailing Address - Phone:301-702-2700
Mailing Address - Fax:301-702-2777
Practice Address - Street 1:3611 BRANCH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-702-2700
Practice Address - Fax:301-702-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty