1972762813 NPI number — ALL SMILES DENTAL CARE

Table of content: (NPI 1972762813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972762813 NPI number — ALL SMILES DENTAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL SMILES DENTAL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972762813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3847 BRANCH AVE
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
TEMPLE HILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20748-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-702-4080
Provider Business Mailing Address Fax Number:
301-702-4081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3847 BRANCH AVE
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-702-4080
Provider Business Practice Location Address Fax Number:
301-702-4081
Provider Enumeration Date:
06/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OBIANWU
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
O
Authorized Official Title or Position:
MBA
Authorized Official Telephone Number:
301-702-4080

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010761101 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".