Provider Demographics
NPI:1154962579
Name:HAGERSTOWN SMILES DENTAL CARE, PA
Entity type:Organization
Organization Name:HAGERSTOWN SMILES DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-739-7003
Mailing Address - Street 1:1115 MOUNT AETNA RD STE UNIT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6806
Mailing Address - Country:US
Mailing Address - Phone:301-739-7003
Mailing Address - Fax:301-739-7910
Practice Address - Street 1:1115 MOUNT AETNA RD STE UNIT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6806
Practice Address - Country:US
Practice Address - Phone:301-739-7003
Practice Address - Fax:301-739-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental