Provider Demographics
NPI:1659966836
Name:SMILE LOFT LANDOVER DENTAL LLC
Entity Type:Organization
Organization Name:SMILE LOFT LANDOVER DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAIBHAV
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-577-6333
Mailing Address - Street 1:7101 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2129
Mailing Address - Country:US
Mailing Address - Phone:301-577-6333
Mailing Address - Fax:
Practice Address - Street 1:7101 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-2129
Practice Address - Country:US
Practice Address - Phone:301-577-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD046068200Medicaid