MEDICARE: SMILE LOFT DENTAL AT HILLANDALE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588325039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE LOFT DENTAL AT HILLANDALE, LLC

Provider Business Mailing Address
First Line	:	10230 NEW HAMPSHIRE AVE STE 101
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1422
Country	:	US
Telephone Number	:	301-445-5821
Fax Number	:

Provider Business Practice Location Address
First Line	:	10230 NEW HAMPSHIRE AVE STE 101
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1422
Country	:	US
Telephone Number	:	301-445-5821
Fax Number	:

Authorized Official
Title or Position	:	CO-PARTNER
Name	:	PRIYA PATEL
Credential	:	DDS
Telephone Number	:	317-331-5490

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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