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General NPI Number Information
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NPI Number | 1295469633
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Entity Type | Organization
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Legal Business Name | SMILE HQ MITCHELLVILLE
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 12150 ANNAPOLIS RD STE 301
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City | GLENN DALE
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State | MD
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Zip | 20769-9183
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Country | US
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Telephone | 301-202-3499
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Fax |
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Provider Business Mailing Address
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Address Line | 14300 GALLANT FOX LN STE 112
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City | BOWIE
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State | MD
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Zip | 20715-4031
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Country | US
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Telephone | 301-262-8500
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. EMIKE USMAN-ALIU
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Credential | DDS
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Telephone | 301-202-3499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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