Provider Demographics
NPI:1013766997
Name:AUTUMN BLISS LLC
Entity type:Organization
Organization Name:AUTUMN BLISS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATOYA
Authorized Official - Middle Name:ROSEMARIE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-298-3452
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3525
Mailing Address - Country:US
Mailing Address - Phone:502-298-3452
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3525
Practice Address - Country:US
Practice Address - Phone:502-298-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty