Provider Demographics
NPI:1770200883
Name:SL SAMPLE, DDS LLC
Entity type:Organization
Organization Name:SL SAMPLE, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEMIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-449-2800
Mailing Address - Street 1:6339 ALLENTOWN RD E
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2600
Mailing Address - Country:US
Mailing Address - Phone:301-449-2800
Mailing Address - Fax:301-449-2802
Practice Address - Street 1:6339 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20748-2600
Practice Address - Country:US
Practice Address - Phone:301-449-2800
Practice Address - Fax:301-449-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental