Healthcare Provider Details

I. General information

NPI: 1699260968
Provider Name (Legal Business Name): SMILE SOLUTIONS OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 YORK RD
BALTIMORE MD
21212-2032
US

IV. Provider business mailing address

6601 YORK RD
BALTIMORE MD
21212-2032
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-2000
  • Fax: 410-377-2145
Mailing address:
  • Phone: 410-377-2000
  • Fax: 410-377-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number14912
License Number StateMD

VIII. Authorized Official

Name: MICHAEL FENLON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 410-377-2000