Provider Demographics
NPI:1093560468
Name:THE FAMILY SMILE SHOP, LLC
Entity Type:Organization
Organization Name:THE FAMILY SMILE SHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARVER-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-350-6933
Mailing Address - Street 1:3060 MITCHELLVILLE RD STE 213
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3972
Mailing Address - Country:US
Mailing Address - Phone:301-350-3932
Mailing Address - Fax:
Practice Address - Street 1:3060 MITCHELLVILLE RD STE 213
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3972
Practice Address - Country:US
Practice Address - Phone:301-350-3932
Practice Address - Fax:301-350-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental