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Organization

CAPITAL DME

Active
Parent organization
CREATIVE SMILE INSTITUTE, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
CREATIVE SMILE INSTITUTE, LLC
Authorized official
DR. OLUWOLE AJAGBE DDS (OWNER)
(202) 239-7108
Entity
Organization

Contact information

Practice address
3636 16TH ST NW, SUITE AG 13, WASHINGTON, DC 20010-1146
(202) 239-7108
Mailing address
3636 16TH ST NW, SUITE AG 13, WASHINGTON, DC 20010-1146
(202) 239-7108

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5263
DC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01801200
DC
Enumeration date
03/30/2017
Last updated
03/30/2017
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