Provider Demographics
NPI:1912417619
Name:NEW SMILES KIDS DENTISTRY
Entity type:Organization
Organization Name:NEW SMILES KIDS DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARAYANI
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALIGA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-747-6543
Mailing Address - Street 1:9815 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2099
Mailing Address - Country:US
Mailing Address - Phone:301-747-6547
Mailing Address - Fax:
Practice Address - Street 1:9815 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2099
Practice Address - Country:US
Practice Address - Phone:301-747-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X
MD15105261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15105OtherDHMH
1194915025OtherPERSONAL NPI