Provider Demographics
NPI:1881899045
Name:NORTH POTOMAC SMILES LLC
Entity type:Organization
Organization Name:NORTH POTOMAC SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIM
Authorized Official - Middle Name:ELIE
Authorized Official - Last Name:KODSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-926-4408
Mailing Address - Street 1:11906 DARNESTOWN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2200
Mailing Address - Country:US
Mailing Address - Phone:301-926-4408
Mailing Address - Fax:
Practice Address - Street 1:11906 DARNESTOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2200
Practice Address - Country:US
Practice Address - Phone:301-926-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty