Organization
HYATTSVILLE PEDIATRICE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KESNEL DUFRESNE DDS (OWNER)
(240) 764-5510
Entity
Organization
Contact information
Practice address
2970 BELCREST CENTER DRIVE, SUITE 105, HYATTSVILLE, MD 20782-1987
(240) 764-5510
(240) 764-5512
Mailing address
2970 BELCREST CENTER DR, SUITE 105, HYATTSVILLE, MD 20782-1987
(240) 764-5510
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
09236
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14445
STATE OF MARYLAND, DEPARTMENT OF HEALTH AND MENTAL HYGIENE, LICENSE
MD
05
—
410995300
—
MD
01
—
D72767
DEPARTMENT OF HEALTH AND MENTAL HYGIENE, DIVISION OF DRUG CONTROL
MD
Enumeration date
10/30/2014
Last updated
03/07/2023
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