Provider Demographics
NPI:1164748711
Name:SMILEWELL, LLC
Entity Type:Organization
Organization Name:SMILEWELL, LLC
Other - Org Name:SMILEWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YUTAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-667-7705
Mailing Address - Street 1:5230 TUCKERMAN LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3474
Mailing Address - Country:US
Mailing Address - Phone:240-667-7705
Mailing Address - Fax:
Practice Address - Street 1:5230 TUCKERMAN LN
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3474
Practice Address - Country:US
Practice Address - Phone:240-667-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty