Provider Demographics
NPI:1497040489
Name:BEAUTIFUL SMILES, L.L.C.
Entity Type:Organization
Organization Name:BEAUTIFUL SMILES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONGELA
Authorized Official - Middle Name:LATARSHA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-868-8545
Mailing Address - Street 1:9001 STUART LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2744
Mailing Address - Country:US
Mailing Address - Phone:301-868-8545
Mailing Address - Fax:301-868-1757
Practice Address - Street 1:9001 STUART LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2744
Practice Address - Country:US
Practice Address - Phone:301-868-8545
Practice Address - Fax:301-868-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty