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General NPI Number Information
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NPI Number | 1881963635
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Entity Type | Organization
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Legal Business Name | SMILE RX DENTAL
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 2905 MITCHELLVILLE RD STE 109
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City | BOWIE
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State | MD
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Zip | 20716-3956
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Country | US
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Telephone | 301-806-4851
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 MITCHELLVILLE ROAD STE 108
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City | BOWIE
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State | MD
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Zip | 20716
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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 | DENTIST/OWNER
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Name | DR. AATIFA KHAN
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Credential | DDS
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Telephone | 301-806-4851
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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 | 14105
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License Number State | MD
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