Organization
SUPER KIDS TEETH LLC
Active
Other names
Severn Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOE T MON (CO-OWNER)
(410) 995-8000
Entity
Organization
Contact information
Practice address
2288 BLUE WATER BLVD STE 328, ODENTON, MD 21113-3309
(410) 995-8000
Mailing address
2288 BLUE WATER BLVD STE 328, ODENTON, MD 21113-3309
(410) 995-8000
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59291
—
MD
Enumeration date
07/13/2017
Last updated
07/21/2022
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