Provider Demographics
NPI:1063927119
Name:SMILE SAVERS OF LAUREL
Entity type:Organization
Organization Name:SMILE SAVERS OF LAUREL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOSANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-362-9700
Mailing Address - Street 1:8377 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4831
Mailing Address - Country:US
Mailing Address - Phone:301-362-9700
Mailing Address - Fax:301-362-4306
Practice Address - Street 1:8377 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4831
Practice Address - Country:US
Practice Address - Phone:301-362-9700
Practice Address - Fax:301-362-4306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE SAVERS OF LAUREL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1033178579Medicaid