Organization
SMILE LOFT GLEN BURNIE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE RAI (DIRECTOR OF HR)
(410) 610-3071
Entity
Organization
Contact information
Practice address
325 HOSPITAL DR STE 101, GLEN BURNIE, MD 21061-5806
(410) 768-4488
Mailing address
325 HOSPITAL DR STE 101, GLEN BURNIE, MD 21061-5806
(410) 768-4488
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046068200
—
MD
05
—
057073700
—
DE
Enumeration date
08/03/2020
Last updated
08/03/2020
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