Provider Demographics
NPI:1427418326
Name:HEALTHY SMILES FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-745-0442
Mailing Address - Street 1:13518 MITCHELLS WAY
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 ENGLAR RD
Practice Address - Street 2:SUITE #6
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-2929
Practice Address - Country:US
Practice Address - Phone:410-848-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty