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General NPI Number Information
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NPI Number | 1427418326
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 250 ENGLAR RD SUITE #6
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City | WESTMINSTER
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State | MD
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Zip | 21157-2929
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Country | US
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Telephone | 410-848-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 13518 MITCHELLS WAY
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City | WEST FRIENDSHIP
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State | MD
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Zip | 21794-9405
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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
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Name | FARAH ILYAS
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Credential |
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Telephone | 443-745-0442
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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 | 14577
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License Number State | MD
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