NPIMap

Organization Active NPI

Marlborough Village Pediatric Dental

  • Pediatric Dentistry
  • Upper Marlboro, MD
National Provider Identifier
1710473731
Registry record updated Jul 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
14704 Issued in MD
Legal business name
MARLBOROUGH VILLAGE PEDIATRIC DENTAL
Practice address
5098 Brown Station Rd Ste 260
Upper Marlboro, MD 20772-9124
Phone
(240) 326-3738
NPI assigned
Jul 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2018

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

Authorized official

Name
Dr. Adrian Johnston Wilson, DDSNPI 1518194901
Title
Owner/Dentist
Phone
(443) 280-0968

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 14704 MD Primary

Addresses

Primary practice location

5098 Brown Station Rd Ste 260
Upper Marlboro, MD 20772-9124

Mailing address

14300 Ridge View LN
Laurel, MD 20707-6278
Phone (443) 280-0968

Other identifiers 1

IdentifierTypeStateIssuer
71150100MedicaidMD

National Provider Directory

National Provider Directory

Locations

5098 Brown Station Rd
#260
Upper Marlboro, MD 20772
Phone (240) 326-3738

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530489600000",
    "number": "1710473731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14300 RIDGE VIEW LN",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207076278",
            "telephone_number": "443-280-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5098 BROWN STATION RD STE 260",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207729124",
            "telephone_number": "240-326-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLBOROUGH VILLAGE PEDIATRIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2018-07-02",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ADRIAN",
        "authorized_official_middle_name": "JOHNSTON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "443-280-0968",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "14704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71150100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; 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.