Healthcare Provider Details

I. General information

NPI: 1003581257
Provider Name (Legal Business Name): SMILE ROTUNDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 40TH ST STE213
BALTIMORE MD
21211-2108
US

IV. Provider business mailing address

711 W 40TH ST STE213
BALTIMORE MD
21211-2108
US

V. Phone/Fax

Practice location:
  • Phone: 410-889-7100
  • Fax:
Mailing address:
  • Phone: 410-889-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KOBY ROBERT SARUBIN
Title or Position: DOCTOR OWNER
Credential: DDS
Phone: 410-245-8287