Provider Demographics
NPI:1750948782
Name:AEGIS DENTAL GROUP LLC (DBA SMILES4ALL)
Entity type:Organization
Organization Name:AEGIS DENTAL GROUP LLC (DBA SMILES4ALL)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-310-4851
Mailing Address - Street 1:12092 ELL LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3522
Mailing Address - Country:US
Mailing Address - Phone:301-645-7777
Mailing Address - Fax:
Practice Address - Street 1:12092 ELL LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3522
Practice Address - Country:US
Practice Address - Phone:301-645-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13764OtherDENTAL LICENSE