MEDICARE: SL SAMPLE, DDS 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	:	1770200883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SL SAMPLE, DDS LLC

Provider Business Mailing Address
First Line	:	6339 ALLENTOWN RD E
Second Line	:
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20748-2600
Country	:	US
Telephone Number	:	301-449-2800
Fax Number	:	301-449-2802

Provider Business Practice Location Address
First Line	:	6339 ALLENTOWN RD
Second Line	:
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20748-2600
Country	:	US
Telephone Number	:	301-449-2800
Fax Number	:	301-449-2802

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	DR. SHEMIKA L SAMPLE
Credential	:	DDS
Telephone Number	:	301-449-2800

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	03/28/2023

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Directions to “SL SAMPLE, DDS LLC ” Practice Location

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