Provider Demographics
NPI:1568501666
Name:DENTAL ENHANCEMENT CENTER LLC
Entity Type:Organization
Organization Name:DENTAL ENHANCEMENT CENTER LLC
Other - Org Name:LIFE SMILES DENTAL ENHANCEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LITTLE RAJASKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-662-6303
Mailing Address - Street 1:198 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4398
Mailing Address - Country:US
Mailing Address - Phone:301-662-6303
Mailing Address - Fax:301-662-7381
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-662-6303
Practice Address - Fax:301-662-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty