Provider Demographics
NPI:1003581257
Name:SMILE ROTUNDA LLC
Entity Type:Organization
Organization Name:SMILE ROTUNDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-245-8287
Mailing Address - Street 1:711 W 40TH ST STE 213
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 W 40TH ST STE 213
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2108
Practice Address - Country:US
Practice Address - Phone:410-889-7100
Practice Address - Fax:410-889-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty