NPIMap

Organization Active NPI

Shadygrove Dental Center

  • Dentist
  • Rockville, MD
National Provider Identifier
1508076787
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10551 Issued in MD
Legal business name
SHADYGROVE DENTAL CENTER
Practice address
14955 Shady Grove Rd Ste 360
Rockville, MD 20850-8719
Phone
(301) 610-7724
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Fabiana Raquel Offit, DDS
Title
Owner
Phone
(301) 610-7724

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 10551 MD Primary

Addresses

Primary practice location

14955 Shady Grove Rd Ste 360
Rockville, MD 20850-8719

Mailing address

14955 Shady Grove Rd Ste 360
Rockville, MD 20850-8719
Phone (301) 610-7724

Other identifiers 1

IdentifierTypeStateIssuer
1093875833OtherMDINDIVIDUAL NPI#

National Provider Directory

National Provider Directory
Tax ID family
Shady Grove Dental Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508076787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14955 SHADY GROVE RD STE 360",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208508719",
            "telephone_number": "301-610-7724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14955 SHADY GROVE RD STE 360",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208508719",
            "telephone_number": "301-610-7724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADYGROVE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OFFIT",
        "authorized_official_first_name": "FABIANA",
        "authorized_official_middle_name": "RAQUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-610-7724",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "10551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI#",
            "identifier": "1093875833",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.