Provider Demographics
NPI:1609412592
Name:NUCLEAR SMILES LLC
Entity Type:Organization
Organization Name:NUCLEAR SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-538-0719
Mailing Address - Street 1:2104 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8135
Mailing Address - Country:US
Mailing Address - Phone:301-538-0719
Mailing Address - Fax:
Practice Address - Street 1:10100 TWIN RIVERS RD APT 121
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2578
Practice Address - Country:US
Practice Address - Phone:301-538-0719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE VILLAGE ORTHODONTIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty