Provider Demographics
NPI:1396898490
Name:THE SMILE WIZARDS
Entity type:Organization
Organization Name:THE SMILE WIZARDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-295-3265
Mailing Address - Street 1:8170 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2537
Mailing Address - Country:US
Mailing Address - Phone:240-295-3265
Mailing Address - Fax:240-295-3270
Practice Address - Street 1:8170 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2537
Practice Address - Country:US
Practice Address - Phone:240-295-3265
Practice Address - Fax:240-295-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty