Healthcare Provider Details

I. General information

NPI: 1093431397
Provider Name (Legal Business Name): CHESAPEAKE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 BLUE WATER BLVD STE 420
ODENTON MD
21113-3312
US

IV. Provider business mailing address

2288 BLUE WATER BLVD STE 420
ODENTON MD
21113-3312
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-0000
  • Fax:
Mailing address:
  • Phone: 410-672-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALIREZA RAJAEI
Title or Position: OWNER
Credential:
Phone: 301-438-1200