Basic Information
| Provider Information | |||||||||
| NPI: | 1316328586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NUSMILES ORTHODONTICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 WATERLOO RD | ||||||||
| Address2: | #220 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210452630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106308189 | ||||||||
| FaxNumber: | 4106181078 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 WATERLOO RD | ||||||||
| Address2: | #220 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210452630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106308189 | ||||||||
| FaxNumber: | 4106181078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2015 | ||||||||
| LastUpdateDate: | 06/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | WANG | ||||||||
| AuthorizedOfficialFirstName: | ALICE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4106308189 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DMD, MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 15419 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.