Provider Demographics
NPI:1376362558
Name:PEDIATRIC DENTISTRY ASLEEP OF MARYLAND LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY ASLEEP OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-672-4077
Mailing Address - Street 1:500 N LEWIS RUN RD STE 215A
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3009
Mailing Address - Country:US
Mailing Address - Phone:412-672-4077
Mailing Address - Fax:412-672-4570
Practice Address - Street 1:60 THOMAS JOHNSON DR STE 2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4685
Practice Address - Country:US
Practice Address - Phone:412-672-4077
Practice Address - Fax:412-672-4570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC DENTISTRY ASLEEP GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty