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General NPI Number Information
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NPI Number | 1033618780
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Entity Type | Organization
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Legal Business Name | GROWING SMILES OF HAVRE DE GRACE LLC
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2012 S TOLLGATE RD STE 212
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City | BEL AIR
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State | MD
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Zip | 21015
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Country | US
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Telephone | 410-569-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 2012 S TOLLGATE RD STE 212
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City | BEL AIR
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State | MD
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Zip | 21015
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Country | US
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Telephone | 410-569-6700
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Fax |
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Authorized Official
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Title or Position | SENIOR CREDENTIALING TEAM LEAD
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Name | JENNY GARCIA-ROCHA
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12180
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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