Provider Demographics
NPI:1114658788
Name:WE MAKE KIDS SMILE, LLC
Entity Type:Organization
Organization Name:WE MAKE KIDS SMILE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGUTO
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-963-0015
Mailing Address - Street 1:1511 MILLERS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-3113
Mailing Address - Country:US
Mailing Address - Phone:410-586-3150
Mailing Address - Fax:
Practice Address - Street 1:3460 OLD WASHINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3242
Practice Address - Country:US
Practice Address - Phone:301-645-6556
Practice Address - Fax:301-638-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty