Organization
SHADY GROVE MODERN DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUY TAM TRAN KIEM DMD (PRESIDENT)
(301) 330-4613
Entity
Organization
Contact information
Practice address
9051 SHADY GROVE COURT, GAITHERSBURG, MD 20877
(301) 330-4613
(301) 330-4619
Mailing address
9051 SHADY GROVE COURT, GAITHERSBURG, MD 20877
(301) 330-4613
(301) 330-4619
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11662
MD
Other
Enumeration date
06/20/2006
Last updated
08/22/2020
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