Organization
ORTHO SUITE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK BLANK DDS (PRESIDENT)
(949) 302-5146
Entity
Organization
Contact information
Practice address
5642 SHIELDS DR, BETHESDA, MD 20817-3573
(301) 363-9026
Mailing address
5642 SHIELDS DR, BETHESDA, MD 20817-3573
(301) 363-9026
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
04/07/2021
Last updated
04/07/2021
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