Provider Demographics
NPI:1972659779
Name:THE SMILE CENTER
Entity Type:Organization
Organization Name:THE SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-732-6720
Mailing Address - Street 1:1500 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1418
Mailing Address - Country:US
Mailing Address - Phone:410-732-6720
Mailing Address - Fax:410-563-5051
Practice Address - Street 1:1500 E MADISON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1418
Practice Address - Country:US
Practice Address - Phone:410-732-6720
Practice Address - Fax:410-563-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD66901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty