=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063821692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLISSFUL DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2014
-----------------------------------------------------
Last Update Date | 05/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9821 GREENBELT RD STE 205
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-552-2662
-----------------------------------------------------
Fax | 301-552-6643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9821 GREENBELT RD SUITE #205
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-552-2662
-----------------------------------------------------
Fax | 301-552-6643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. BRENDA ELAINE HOWARD
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 301-552-2662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | MD7778
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------