Organization
BETHESDA ORTHODONTIC SPECIALIST
Active
Other names
Bethesda Dental Specialties
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN LY (MANAGER)
(301) 654-3011
Entity
Organization
Contact information
Practice address
4405 E WEST HWY STE 102, BETHESDA, MD 20814-4532
(301) 654-3011
Mailing address
4405 E WEST HWY STE 102, BETHESDA, MD 20814-4532
(301) 654-3011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
05/04/2021
Last updated
06/15/2021
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