Healthcare Provider Details

I. General information

NPI: 1366370025
Provider Name (Legal Business Name): SMILEWORKS DENTAL & ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 45TH ST STE 210
RIVERDALE PARK MD
20737-1165
US

IV. Provider business mailing address

6730 45TH ST STE 210
RIVERDALE PARK MD
20737-1165
US

V. Phone/Fax

Practice location:
  • Phone: 301-213-0396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JIM O OGUNTIMEIN
Title or Position: CEO
Credential:
Phone: 301-213-0396