Provider Demographics
NPI:1831644988
Name:GROWING SMILES WHITE MARSH LLC
Entity Type:Organization
Organization Name:GROWING SMILES WHITE MARSH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-697-9000
Mailing Address - Street 1:11570 CROSSROADS CIR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2861
Mailing Address - Country:US
Mailing Address - Phone:410-697-9000
Mailing Address - Fax:
Practice Address - Street 1:11570 CROSSROADS CIR
Practice Address - Street 2:SUITE 116
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2861
Practice Address - Country:US
Practice Address - Phone:410-697-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty