Healthcare Provider Details

I. General information

NPI: 1982478764
Provider Name (Legal Business Name): SYDNE PAIGE SMITH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/19/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9881 BROKEN LAND PKWY STE 102
COLUMBIA MD
21046-3010
US

IV. Provider business mailing address

120 FORT DR NE APT 2
WASHINGTON DC
20011-7418
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-1344
  • Fax:
Mailing address:
  • Phone: 301-787-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHYG2001214
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: