NPIMap

Organization Active NPI

Moco Pediatric Dentistry LLC

Doing business as Plover Pediatric Dentistry

  • Pediatric Dentistry
  • Potomac, MD
National Provider Identifier
1811571318
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
MOCO PEDIATRIC DENTISTRY LLC
Doing business as
Plover Pediatric Dentistry
Practice address
11325 Seven Locks Rd Ste 250
Potomac, MD 20854-3269
Phone
(406) 423-1612
Fax
(240) 642-3161
NPI assigned
May 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Authorized official

Name
Hae Jin Kim, DDSNPI 1104104132
Title
Pediatric Dentist
Phone
(240) 642-3161

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 Primary

Addresses

Primary practice location

11325 Seven Locks Rd Ste 250
Potomac, MD 20854-3269

Mailing address

11325 Seven Locks Rd Ste 250
Potomac, MD 20854-3269
Phone (240) 642-3161

Other names 1

  • Plover Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

11325 Seven Locks Rd
Ste 250
Potomac, MD 20854
Phone (240) 642-3161

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1811571318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11325 SEVEN LOCKS RD STE 250",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543269",
            "telephone_number": "240-642-3161",
            "fax_number": "240-642-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 SEVEN LOCKS RD STE 250",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543269",
            "telephone_number": "406-423-1612",
            "fax_number": "240-642-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOCO PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "HAE JIN",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "240-642-3161",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plover Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Plover Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potomac, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; 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.