Provider Demographics
NPI:1780894956
Name:SHADY GROVE DENTAL CENTER, LLC
Entity type:Organization
Organization Name:SHADY GROVE DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-610-7724
Mailing Address - Street 1:14955 SHADY GROVE RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8700
Mailing Address - Country:US
Mailing Address - Phone:301-610-7724
Mailing Address - Fax:301-610-7735
Practice Address - Street 1:14955 SHADY GROVE RD
Practice Address - Street 2:SUITE 360
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8700
Practice Address - Country:US
Practice Address - Phone:301-610-7724
Practice Address - Fax:301-610-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1649330473OtherINDIVIDUAL NPI NUMBER