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General NPI Number Information
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NPI Number | 1316328586
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Entity Type | Organization
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Legal Business Name | NUSMILES ORTHODONTICS
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Dates
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Enumeration Date | 06/14/2015
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Last Update Date | 06/14/2015
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Provider Practice Location Address
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Address Line | 5900 WATERLOO RD #220
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City | COLUMBIA
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State | MD
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Zip | 21045-2630
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Country | US
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Telephone | 410-630-8189
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Fax | 410-618-1078
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Provider Business Mailing Address
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Address Line | 5900 WATERLOO RD #220
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City | COLUMBIA
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State | MD
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Zip | 21045-2630
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Country | US
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Telephone | 410-630-8189
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Fax | 410-618-1078
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALICE C WANG
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Credential | DMD, MS
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Telephone | 410-630-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 15419
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License Number State | MD
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