Provider Demographics
NPI:1669203931
Name:SANDY SPRING SMILES
Entity type:Organization
Organization Name:SANDY SPRING SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REESE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-624-9717
Mailing Address - Street 1:605 OLNEY SANDY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1012
Mailing Address - Country:US
Mailing Address - Phone:301-774-8555
Mailing Address - Fax:
Practice Address - Street 1:605 OLNEY SANDY SPRING RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1012
Practice Address - Country:US
Practice Address - Phone:301-774-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336542398OtherNPI
FL1861807802OtherNPI