Healthcare Provider Details

I. General information

NPI: 1033618780
Provider Name (Legal Business Name): GROWING SMILES OF HAVRE DE GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S TOLLGATE RD STE 212
BEL AIR MD
21015
US

IV. Provider business mailing address

2012 S TOLLGATE RD STE 212
BEL AIR MD
21015
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-6700
  • Fax:
Mailing address:
  • Phone: 410-569-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number12180
License Number StateMD

VIII. Authorized Official

Name: JENNY GARCIA-ROCHA
Title or Position: SENIOR CREDENTIALING TEAM LEAD
Credential:
Phone: 972-869-3789