NPIMap

Organization Active NPI

Clarksburg Dental Center LLC

  • Dental Clinic/Center
  • Clarksburg, MD
National Provider Identifier
1861569485
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
13060 Issued in MD
Legal business name
CLARKSBURG DENTAL CENTER LLC
Practice address
23212 Brewers Tavern Way
Clarksburg, MD 20871-4391
Phone
(301) 515-5525
Fax
(301) 515-9339
NPI assigned
Nov 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Dr. Edmund Y Liu, D.D.S.NPI 1932394913
Title
Dentist
Phone
(301) 515-5525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 13060 MD Primary

Addresses

Primary practice location

23212 Brewers Tavern Way
Clarksburg, MD 20871-4391

Mailing address

23212 Brewers Tavern Way
Clarksburg, MD 20871-4391
Phone (301) 515-5525

National Provider Directory

National Provider Directory
Tax ID family
Clarksburg Dental Center2 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.

Locations

23212 Brewers Tavern Way
Clarksburg, MD 20871
Phone (301) 515-5525

Practitioners & affiliated clinicians

Practitioners 1

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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861569485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23212 BREWERS TAVERN WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714391",
            "telephone_number": "301-515-5525",
            "fax_number": "301-515-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23212 BREWERS TAVERN WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714391",
            "telephone_number": "301-515-5525",
            "fax_number": "301-515-9339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSBURG DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "EDMUND",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "301-515-5525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MD",
            "license": "13060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksburg, 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.