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General NPI Number Information
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NPI Number | 1942548540
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Entity Type | Organization
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Legal Business Name | KIDS SUPER SMILE
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 8600 SNOWDEN RIVER PKWY 302
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City | COLUMBIA
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State | MD
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Zip | 21045-1982
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Country | US
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Telephone | 410-953-0111
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Fax | 410-953-0193
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Provider Business Mailing Address
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Address Line | 8600 SNOWDEN RIVER PKWY 302
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City | COLUMBIA
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State | MD
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Zip | 21045-1982
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Country | US
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Telephone | 410-953-0111
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Fax | 410-953-0193
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Authorized Official
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Title or Position | OFFICER
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Name | DR. XIMENA PAREJA
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Credential | DDS
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Telephone | 410-953-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12833
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License Number State | MD
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