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General NPI Number Information
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NPI Number | 1366370025
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Entity Type | Organization
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Legal Business Name | SMILEWORKS DENTAL & ORTHODONTICS, LLC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 6730 45TH ST STE 210
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City | RIVERDALE PARK
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State | MD
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Zip | 20737-1165
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Country | US
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Telephone | 301-213-0396
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Fax |
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Provider Business Mailing Address
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Address Line | 6730 45TH ST STE 210
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City | RIVERDALE PARK
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State | MD
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Zip | 20737-1165
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JIM O OGUNTIMEIN
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Credential |
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Telephone | 301-213-0396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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