Provider Demographics
NPI:1619347176
Name:SILVER SPRING SMILES, LLC
Entity type:Organization
Organization Name:SILVER SPRING SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AYANA
Authorized Official - Last Name:DUFERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-588-5400
Mailing Address - Street 1:921 ELLSWORTH DR STE B
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4478
Mailing Address - Country:US
Mailing Address - Phone:301-588-5400
Mailing Address - Fax:301-588-5464
Practice Address - Street 1:921 ELLSWORTH DR STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4478
Practice Address - Country:US
Practice Address - Phone:301-588-5400
Practice Address - Fax:301-588-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14480261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD071632400Medicaid