Healthcare Provider Details

I. General information

NPI: 1851907190
Provider Name (Legal Business Name): LAURA ANN SMITH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 EXCHANGE DR STE 116
ELDERSBURG MD
21784-9255
US

IV. Provider business mailing address

1005 CYPRESS FOREST DR
SYKESVILLE MD
21784-7686
US

V. Phone/Fax

Practice location:
  • Phone: 433-300-3185
  • Fax: 443-300-3190
Mailing address:
  • Phone: 410-375-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6580
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: