Organization
CHAMPION SMILES OF MARYLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER GIBBS (PRACTICE MANAGER)
(301) 249-4123
Entity
Organization
Contact information
Practice address
113 LA GRANGE AVE, LA PLATA, MD 20646-9592
(301) 249-4123
Mailing address
PO BOX 2768, LA PLATA, MD 20646-2768
(301) 249-4123
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054215600
—
MD
Enumeration date
03/04/2021
Last updated
03/04/2021
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