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General NPI Number Information
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NPI Number | 1407294788
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Entity Type | Organization
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Legal Business Name | SMILE FREDERICK LLC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 7360 GUILFORD DR
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City | FREDERICK
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State | MD
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Zip | 21704-5124
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Country | US
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Telephone | 301-668-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 7360 GUILFORD DR
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City | FREDERICK
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State | MD
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Zip | 21704-5124
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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 | OWNER DOCTOR
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Name | ROBERT MANSMAN
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Credential | DDS
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Telephone | 301-668-2662
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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 |
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License Number State |
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