Provider Demographics
NPI:1972762813
Name:ALL SMILES DENTAL CARE
Entity type:Organization
Organization Name:ALL SMILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBA
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBIANWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-702-4080
Mailing Address - Street 1:3847 BRANCH AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1407
Mailing Address - Country:US
Mailing Address - Phone:301-702-4080
Mailing Address - Fax:301-702-4081
Practice Address - Street 1:3847 BRANCH AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1407
Practice Address - Country:US
Practice Address - Phone:301-702-4080
Practice Address - Fax:301-702-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010761101Medicaid