NPIMap

Organization Active NPI

Hyattsville Pediatrice Dentistry

  • Pediatric Dentistry
  • Hyattsville, MD
National Provider Identifier
1760887970
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
09236 Issued in MD
Legal business name
HYATTSVILLE PEDIATRICE DENTISTRY
Practice address
2970 Belcrest Center Drive
Suite 105
Hyattsville, MD 20782-1987
Phone
(240) 764-5510
Fax
(240) 764-5512
NPI assigned
Oct 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. Kesnel Dufresne, DDS
Title
Owner
Phone
(240) 764-5510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 09236 MD Primary

Addresses

Primary practice location

2970 Belcrest Center Drive
Suite 105
Hyattsville, MD 20782-1987

Mailing address

2970 Belcrest Center Dr
Suite 105
Hyattsville, MD 20782-1987
Phone (240) 764-5510

Other identifiers 3

IdentifierTypeStateIssuer
14445OtherMDSTATE OF MARYLAND, DEPARTMENT OF HEALTH AND MENTAL HYGIENE, LICENSE
410995300MedicaidMD
D72767OtherMDDEPARTMENT OF HEALTH AND MENTAL HYGIENE, DIVISION OF DRUG CONTROL

National Provider Directory

National Provider Directory

Locations

2970 Belcrest Center Dr
Ste 105
Hyattsville, MD 20782
Phone (240) 764-5510

NPI Registry JSON

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1760887970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 BELCREST CENTER DR",
            "address_2": "SUITE 105",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207821987",
            "telephone_number": "240-764-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 BELCREST CENTER DRIVE",
            "address_2": "SUITE 105",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207821987",
            "telephone_number": "240-764-5510",
            "fax_number": "240-764-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYATTSVILLE PEDIATRICE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "DUFRESNE",
        "authorized_official_first_name": "KESNEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-764-5510",
        "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": "09236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MARYLAND, DEPARTMENT OF HEALTH AND MENTAL HYGIENE, LICENSE",
            "identifier": "14445",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410995300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH AND MENTAL HYGIENE, DIVISION OF DRUG CONTROL",
            "identifier": "D72767",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hyattsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.