Provider Demographics
NPI:1902072408
Name:CHA-CAMP DENTAL LLC
Entity Type:Organization
Organization Name:CHA-CAMP DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:CHA-CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-537-6192
Mailing Address - Street 1:20036 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1604
Mailing Address - Country:US
Mailing Address - Phone:240-683-6009
Mailing Address - Fax:
Practice Address - Street 1:20036 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1604
Practice Address - Country:US
Practice Address - Phone:240-683-6009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13607261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental