Organization
CCDC PROFESSIONALS, LLC
Active
Other names
Capital Children's General Anesthesia Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAMILLE TAYLOR (DIRECTOR OF FINANCE)
(202) 536-9366
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
03/02/2026
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