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General NPI Number Information
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NPI Number | 1114658788
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Entity Type | Organization
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Legal Business Name | WE MAKE KIDS SMILE, LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 3460 OLD WASHINGTON RD STE 200
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City | WALDORF
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State | MD
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Zip | 20602-3242
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Country | US
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Telephone | 301-645-6556
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Fax | 301-638-3131
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Provider Business Mailing Address
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Address Line | 1511 MILLERS WAY
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City | PORT REPUBLIC
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State | MD
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Zip | 20676-3113
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Country | US
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Telephone | 410-586-3150
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Fax |
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Authorized Official
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Title or Position | LLC MEMBER
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Name | FELIX J AGUTO III
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Credential | DDS
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Telephone | 410-963-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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