Organization
CREATIVE SMILE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUWOLE AJAGBE DDS, MS (AUTHORIZED RRESENTATIVE)
(240) 584-6025
Entity
Organization
Contact information
Practice address
3636 16TH STREET, NW, SUITE AG 13, WASHINGTON, DC 20010-2001
(202) 239-7108
Mailing address
1380 MONROE ST NW # 717, WASHINGTON, DC 20010-3452
(120) 223-9710
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
09/26/2018
Last updated
02/16/2019
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