Provider Demographics
NPI:1295469633
Name:SMILE HQ MITCHELLVILLE
Entity Type:Organization
Organization Name:SMILE HQ MITCHELLVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:USMAN-ALIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-202-3499
Mailing Address - Street 1:14300 GALLANT FOX LN STE 112
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4031
Mailing Address - Country:US
Mailing Address - Phone:301-262-8500
Mailing Address - Fax:
Practice Address - Street 1:12150 ANNAPOLIS RD STE 301
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-202-3499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty