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General NPI Number Information
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NPI Number | 1154551737
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Entity Type | Organization
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Legal Business Name | SMILE AFTER SMILE ,LLC
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 15638 LIVINGSTON RD
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City | ACCOKEEK
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State | MD
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Zip | 20607-3333
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Country | US
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Telephone | 240-606-8052
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Fax |
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Provider Business Mailing Address
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Address Line | 15638 LIVINGSTON ROAD
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City | ACCOKEEK
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State | MD
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Zip | 20607
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Country | US
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Telephone | 240-606-8052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EVELYN CAMPBELL-LEACH
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Credential | DDS
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Telephone | 240-606-8052
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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 | MD09266
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License Number State | MD
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