Provider Demographics
NPI:1528276599
Name:JEFFERSON FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:JEFFERSON FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:CASTILLO
Authorized Official - Last Name:KALER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-834-8804
Mailing Address - Street 1:3733 JEFFERSON PIKE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MD
Mailing Address - Zip Code:21755
Mailing Address - Country:US
Mailing Address - Phone:301-834-8804
Mailing Address - Fax:
Practice Address - Street 1:3733 JEFFERSON PIKE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MD
Practice Address - Zip Code:21755
Practice Address - Country:US
Practice Address - Phone:301-834-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD085691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty