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General NPI Number Information
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NPI Number | 1669760195
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Entity Type | Organization
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Legal Business Name | DIVINE SMILES DENTISTRY
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 8001 WISCONSIN AVE SUITE 103
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City | BETHESDA
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State | MD
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Zip | 20814-3602
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Country | US
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Telephone | 301-613-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 8001 WISCONSIN AVE SUITE 103
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City | BETHESDA
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State | MD
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Zip | 20814-3602
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Country | US
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Telephone | 301-613-3211
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ROCHELLE NUNEZ
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Credential |
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Telephone | 301-613-3211
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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 | 13779
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License Number State | MD
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