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General NPI Number Information
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NPI Number | 1619347176
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Entity Type | Organization
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Legal Business Name | SILVER SPRING SMILES, LLC
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Dates
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Enumeration Date | 09/28/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 921 ELLSWORTH DR STE B
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City | SILVER SPRING
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State | MD
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Zip | 20910-4478
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Country | US
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Telephone | 301-588-5400
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Fax | 301-588-6454
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Provider Business Mailing Address
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Address Line | 921 ELLSWORTH DR STE B
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City | SILVER SPRING
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State | MD
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Zip | 20910-4478
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Country | US
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Telephone | 301-588-5400
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Fax | 301-588-5464
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL AYANA DUFERA
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Credential | DDS
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Telephone | 301-588-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 14480
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License Number State | MD
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