Provider Demographics
NPI:1093431397
Name:CHESAPEAKE SMILES
Entity Type:Organization
Organization Name:CHESAPEAKE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-438-1200
Mailing Address - Street 1:2288 BLUE WATER BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3312
Mailing Address - Country:US
Mailing Address - Phone:410-672-0000
Mailing Address - Fax:
Practice Address - Street 1:2288 BLUE WATER BLVD STE 420
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3312
Practice Address - Country:US
Practice Address - Phone:410-672-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R3 DENTAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty