Healthcare Provider Details

I. General information

NPI: 1154551737
Provider Name (Legal Business Name): SMILE AFTER SMILE ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15638 LIVINGSTON RD
ACCOKEEK MD
20607-3333
US

IV. Provider business mailing address

15638 LIVINGSTON ROAD
ACCOKEEK MD
20607
US

V. Phone/Fax

Practice location:
  • Phone: 240-606-8052
  • Fax:
Mailing address:
  • Phone: 240-606-8052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberMD09266
License Number StateMD

VIII. Authorized Official

Name: DR. EVELYN CAMPBELL-LEACH
Title or Position: OWNER
Credential: DDS
Phone: 240-606-8052