Provider Demographics
NPI:1144648445
Name:DAMASCUS DENTAL GROUP, CHARTERED
Entity type:Organization
Organization Name:DAMASCUS DENTAL GROUP, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:JING-HAY
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-253-2174
Mailing Address - Street 1:9701 NEW CHURCH ST
Mailing Address - Street 2:#9
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2000
Mailing Address - Country:US
Mailing Address - Phone:301-253-2174
Mailing Address - Fax:301-253-9693
Practice Address - Street 1:9701 NEW CHURCH ST
Practice Address - Street 2:#9
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2000
Practice Address - Country:US
Practice Address - Phone:301-253-2174
Practice Address - Fax:301-253-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty