Provider Demographics
NPI:1588250237
Name:UB CLINTON DENTAL GROUP
Entity type:Organization
Organization Name:UB CLINTON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JANASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-915-4504
Mailing Address - Street 1:9131 PISCATAWAY RD STE 739
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2570
Mailing Address - Country:US
Mailing Address - Phone:917-915-4504
Mailing Address - Fax:
Practice Address - Street 1:9131 PISCATAWAY RD STE 739
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2570
Practice Address - Country:US
Practice Address - Phone:917-915-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental