Provider Demographics
NPI:1730463456
Name:CHESAPEAKE SMILES, LLC
Entity Type:Organization
Organization Name:CHESAPEAKE SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OQBA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-672-0000
Mailing Address - Street 1:2288 BLUE WATER BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3309
Mailing Address - Country:US
Mailing Address - Phone:410-672-0000
Mailing Address - Fax:443-645-0214
Practice Address - Street 1:2288 BLUE WATER BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3309
Practice Address - Country:US
Practice Address - Phone:410-672-0000
Practice Address - Fax:443-645-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty