Provider Demographics
NPI:1811441108
Name:SMILE LOFT BETHESDA LLC
Entity type:Organization
Organization Name:SMILE LOFT BETHESDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAIBHAV
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-264-5015
Mailing Address - Street 1:7201 WISCONSIN AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4810
Mailing Address - Country:US
Mailing Address - Phone:301-264-5015
Mailing Address - Fax:301-264-5014
Practice Address - Street 1:7201 WISCONSIN AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4810
Practice Address - Country:US
Practice Address - Phone:301-264-5015
Practice Address - Fax:301-264-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD057073700Medicaid