Healthcare Provider Details

I. General information

NPI: 1003509274
Provider Name (Legal Business Name): HEALTHY SMILES DENTALCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11016 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2602
US

IV. Provider business mailing address

11016 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2602
US

V. Phone/Fax

Practice location:
  • Phone: 703-623-2388
  • Fax:
Mailing address:
  • Phone: 703-623-2388
  • 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: QING XU
Title or Position: DENTIST/OWNER
Credential:
Phone: 703-623-2388