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Organization
CCDC PROFESSIONALS, LLC
Active
Organization
CCDC PROFESSIONALS, LLC
Active
Other names
Capital Children's General Anesthesia Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY WHEELER (CEO)
(301) 494-3000
Entity
Organization
Contact information
Practice address
1220 CARAWAY CT STE 1050, UPPER MARLBORO, MD 20774-5338
(301) 494-3000
(301) 494-3333
Mailing address
1220 CARAWAY CT STE 1050, UPPER MARLBORO, MD 20774-5338
(301) 494-3000
(301) 494-3333
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0004X
Dental Anesthesiology
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023307055
NPI
—
Enumeration date
10/13/2016
Last updated
08/17/2026
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