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General NPI Number Information
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NPI Number | 1609412592
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Entity Type | Organization
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Legal Business Name | NUCLEAR SMILES LLC
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 10100 TWIN RIVERS RD APT 121
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City | COLUMBIA
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State | MD
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Zip | 21044-2578
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Country | US
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Telephone | 301-538-0719
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 DIXON RD
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City | FREDERICK
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State | MD
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Zip | 21704-8135
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Country | US
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Telephone | 301-538-0719
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON A MOLES
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Credential | DDS
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Telephone | 301-538-0719
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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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