Provider Demographics
NPI:1992168082
Name:FAMILY & AESTHETIC DENTISTRY
Entity type:Organization
Organization Name:FAMILY & AESTHETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEECHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-725-1002
Mailing Address - Street 1:1003 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3801
Mailing Address - Country:US
Mailing Address - Phone:301-725-1002
Mailing Address - Fax:301-725-1150
Practice Address - Street 1:1003 4TH ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3801
Practice Address - Country:US
Practice Address - Phone:301-725-1002
Practice Address - Fax:301-725-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty