Provider Demographics
NPI:1154690501
Name:SMILEDMD OF MARYLAND, LLC
Entity Type:Organization
Organization Name:SMILEDMD OF MARYLAND, LLC
Other - Org Name:OWINGS MILLS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOONCHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-363-7374
Mailing Address - Street 1:90 PAINTERS MILL RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3630
Mailing Address - Country:US
Mailing Address - Phone:410-363-7374
Mailing Address - Fax:410-363-8830
Practice Address - Street 1:90 PAINTERS MILL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3630
Practice Address - Country:US
Practice Address - Phone:410-363-7374
Practice Address - Fax:410-363-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty