| Champion Smiles Of Maryland Llc | |
|
113 La Grange Ave La Plata MD 20646-9592 | |
| (301) 249-4123 | |
| Not Available |
| Full Name | Champion Smiles Of Maryland Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 113 La Grange Ave, La Plata, Maryland |
| Authorized Official Name and Position | Amber Gibbs (PRACTICE MANAGER) |
| Authorized Official Contact | 3012494123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Champion Smiles Of Maryland Llc Po Box 2768 La Plata MD 20646-2768 Ph: (301) 249-4123 | Champion Smiles Of Maryland Llc 113 La Grange Ave La Plata MD 20646-9592 Ph: (301) 249-4123 |
| NPI Number | 1396330049 |
|---|---|
| Provider Enumeration Date | 03/04/2021 |
| Last Update Date | 03/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396330049 | NPI | - | NPPES |
| 054215600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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