Provider Demographics
NPI:1134900145
Name:SMILE.LI DENTAL
Entity type:Organization
Organization Name:SMILE.LI DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SICONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:443-393-3988
Mailing Address - Street 1:1730 E EAGER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1112
Mailing Address - Country:US
Mailing Address - Phone:314-583-9613
Mailing Address - Fax:
Practice Address - Street 1:7625 MAPLE LAWN BLVD STE 155
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2598
Practice Address - Country:US
Practice Address - Phone:443-393-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental