Provider Demographics
NPI:1457944985
Name:SMILE EXPERTS
Entity type:Organization
Organization Name:SMILE EXPERTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDLEEB
Authorized Official - Middle Name:REHMAN
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-877-4989
Mailing Address - Street 1:10658 CANTERBERRY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1924
Mailing Address - Country:US
Mailing Address - Phone:630-877-4989
Mailing Address - Fax:
Practice Address - Street 1:1747 PENNSYLVANIA AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-4604
Practice Address - Country:US
Practice Address - Phone:630-877-4989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1326423005Medicaid