Organization
SHADYGROVE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FABIANA RAQUEL OFFIT DDS (OWNER)
(301) 610-7724
Entity
Organization
Contact information
Practice address
14955 SHADY GROVE RD STE 360, ROCKVILLE, MD 20850-8719
(301) 610-7724
Mailing address
14955 SHADY GROVE RD STE 360, ROCKVILLE, MD 20850-8719
(301) 610-7724
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10551
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093875833
INDIVIDUAL NPI#
MD
Enumeration date
05/23/2007
Last updated
08/22/2020
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