Provider Demographics
NPI:1861669236
Name:MILES OF SMILES DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:MILES OF SMILES DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOUMBISSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:301-317-9020
Mailing Address - Street 1:14333 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1126
Mailing Address - Country:US
Mailing Address - Phone:301-317-9020
Mailing Address - Fax:301-317-0282
Practice Address - Street 1:14333 LAUREL BOWIE RD
Practice Address - Street 2:SUITE # 307
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1126
Practice Address - Country:US
Practice Address - Phone:301-317-9020
Practice Address - Fax:301-317-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty