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Organization
SHADY GROVE CHILDREN'S GAD, LLC
Active
Organization
SHADY GROVE CHILDREN'S GAD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY WHEELER (CEO)
(301) 494-3000
Entity
Organization
Contact information
Practice address
15001 SHADY GROVE RD STE 110, ROCKVILLE, MD 20850-6354
(301) 494-3000
Mailing address
1220 CARAWAY CT STE 1050, UPPER MARLBORO, MD 20774-5338
(301) 494-3000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0004X
Dental Anesthesiology
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
207L00000X
Anesthesiology Physician
—
—
207LP3000X
Pediatric Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
05/11/2023
Last updated
01/13/2026
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