MEDICARE: SMILELOFT LANDOVER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15036	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871037788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILELOFT LANDOVER LLC

Provider Business Mailing Address
First Line	:	7101 ANNAPOLIS RD
Second Line	:
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-2129
Country	:	US
Telephone Number	:	301-577-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 ANNAPOLIS RD
Second Line	:
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-2129
Country	:	US
Telephone Number	:	301-577-6333
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. ROSHAN JARDOSH
Credential	:
Telephone Number	:	301-577-6333

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	12/12/2016

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Directions to “SMILELOFT LANDOVER LLC ” Practice Location

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