Provider Demographics
NPI:1932070943
Name:ESTHETIC SMILE LLC
Entity type:Organization
Organization Name:ESTHETIC SMILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONDO BENGONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-762-5552
Mailing Address - Street 1:50 W EDMONSTON DR STE 605
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1254
Mailing Address - Country:US
Mailing Address - Phone:301-762-5552
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 605
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1254
Practice Address - Country:US
Practice Address - Phone:301-762-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty