NPIMap

Organization Active NPI

Bethesda Pediatric Dentistry LLC

  • Dentist
  • Bethesda, MD
National Provider Identifier
1760858518
Registry record updated Dec 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8760 Issued in DC
Legal business name
BETHESDA PEDIATRIC DENTISTRY LLC
Practice address
4405 E West Hwy
Suite 102
Bethesda, MD 20814-4522
Phone
(301) 654-3011
NPI assigned
Aug 17, 2015
Last updated
Dec 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2015

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

Authorized official

Name
Mr. Aris Fajardo
Title
Manager
Phone
(301) 654-3011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8760 DC Primary

Addresses

Primary practice location

4405 E West Hwy
Suite 102
Bethesda, MD 20814-4522

Mailing address

4405 E West Hwy
Suite 102
Bethesda, MD 20814-4522
Phone (301) 654-3011

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1760858518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 E WEST HWY",
            "address_2": "SUITE 102",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208144522",
            "telephone_number": "301-654-3011",
            "fax_number": "301-986-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 E WEST HWY",
            "address_2": "SUITE 102",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208144522",
            "telephone_number": "301-654-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHESDA PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "ARIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-654-3011",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "8760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; 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.