Provider Demographics
NPI:1992138697
Name:BETHESDA CHEVY CHASE DENTAL CARE
Entity type:Organization
Organization Name:BETHESDA CHEVY CHASE DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-986-8777
Mailing Address - Street 1:6831 WISCONSIN AVE
Mailing Address - Street 2:P101
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6122
Mailing Address - Country:US
Mailing Address - Phone:301-986-8777
Mailing Address - Fax:301-986-8873
Practice Address - Street 1:6831 WISCONSIN AVE
Practice Address - Street 2:P101
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6122
Practice Address - Country:US
Practice Address - Phone:301-986-8777
Practice Address - Fax:301-986-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039934100Medicaid