Provider Demographics
NPI:1871056416
Name:SMILE DENTAL
Entity type:Organization
Organization Name:SMILE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJWANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-438-2003
Mailing Address - Street 1:2621 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1912
Mailing Address - Country:US
Mailing Address - Phone:301-949-4600
Mailing Address - Fax:301-438-3781
Practice Address - Street 1:2621 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1912
Practice Address - Country:US
Practice Address - Phone:301-949-4600
Practice Address - Fax:301-949-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD63951Medicaid