Provider Demographics
NPI:1154551737
Name:SMILE AFTER SMILE ,LLC
Entity type:Organization
Organization Name:SMILE AFTER SMILE ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL-LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-606-8052
Mailing Address - Street 1:15638 LIVINGSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607
Mailing Address - Country:US
Mailing Address - Phone:240-606-8052
Mailing Address - Fax:
Practice Address - Street 1:15638 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3333
Practice Address - Country:US
Practice Address - Phone:240-606-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD09266261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental