NPIMap

Organization Active NPI

Prince George'S County Health Department

  • Public Health Dentistry
  • Cheverly, MD
National Provider Identifier
1114155694
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
Legal business name
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Practice address
3003 Hospital Dr Ste 1048
Cheverly, MD 20785-1194
Phone
(301) 583-5900
Fax
(301) 883-7890
NPI assigned
Jun 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tamala Butler
Title
Credentialing Specialist
Phone
(301) 883-7822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X Primary

Addresses

Primary practice location

3003 Hospital Dr Ste 1048
Cheverly, MD 20785-1194

Mailing address

1701 McCormick Dr
Largo, MD 20774-5329
Phone (301) 583-5900

Other identifiers 1

IdentifierTypeStateIssuer
417155100MedicaidMD

Other names 1

  • Prince George's County Health Department- Dental Other name

National Provider Directory

National Provider Directory
Tax ID family
Prince Georges County48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Locations

4200 57th Ave
Bladensburg, MD 20710
Phone (240) 696-3356

1401 Nye St
Capitol Heights, MD 20743

3003 Hospital Dr
Ste 1048
Cheverly, MD 20785
Phone (301) 583-5900

7000 Adelphi Rd
Hyattsville, MD 20782
Phone (301) 749-4722

4390 Parliament Pl
Ste A
Lanham, MD 20706
Phone (301) 552-8803

14207 Park Center Dr
#101103
Laurel, MD 20707

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1114155694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 MCCORMICK DR",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207745329",
            "telephone_number": "301-583-5900",
            "fax_number": "301-883-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HOSPITAL DR STE 1048",
            "city": "CHEVERLY",
            "state": "MD",
            "postal_code": "207851194",
            "telephone_number": "301-583-5900",
            "fax_number": "301-883-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "TAMALA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "301-883-7822",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "417155100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prince George's County Health Department- Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cheverly, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.