Individual
DR. GHASSAN ELIAS JACKLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
11125 ROCKVILLE PIKE STE 204, ROCKVILLE, MD 20852-3142
(301) 888-6666
Mailing address
11125 ROCKVILLE PIKE STE 204, ROCKVILLE, MD 20852-3142
(301) 888-6666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1001256
DC
1223G0001X
General Practice Dentistry
Primary
11991
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401413871
LICENSE
VA
01
—
11991
LICENSE NUMBER
MD
Enumeration date
03/30/2013
Last updated
05/07/2018
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