# OCTAVIA SIMKINS-WISEMAN DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mitchellville Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548536949
- **Authorized official:** DR. OCTAVIA SIMKINS-WISEMAN DDS (CEO)
- **Authorized official phone:** (240) 393-9861

## Contact information

- **Practice address:** 12150 ANNAPOLIS ROAD, SUITE 301, GLENN DALE, MD 20769
- **Practice address phone:** (301) 249-8000
- **Practice address fax:** (301) 249-4958
- **Mailing address:** 12150 ANNAPOLIS ROAD, SUITE 301, GLENN DALE, MD 20769
- **Mailing address phone:** (301) 249-2862
- **Mailing address fax:** (301) 249-4958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 10983 | MD | Yes |

## Other

- **Enumeration date:** 03/29/2012
- **Last updated:** 03/18/2013