NPIMap

Organization Active NPI

DC Pediatric Smiles LLC

  • Pediatric Dentistry
  • Bethesda, MD
National Provider Identifier
1124798095
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
DC PEDIATRIC SMILES LLC
Practice address
5640 Shields Dr
Bethesda, MD 20817-3573
Phone
(301) 363-9026
Fax
(301) 363-9669
NPI assigned
Sep 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Derek Blank, DDSNPI 1134449127
Title
President
Phone
(301) 363-9026

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

5640 Shields Dr
Bethesda, MD 20817-3573

Mailing address

5640 Shields Dr
Bethesda, MD 20817-3573
Phone (301) 363-9026

National Provider Directory

National Provider Directory

Locations

5640 Shields Dr
Bethesda, MD 20817
Phone (301) 363-9026

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1124798095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 SHIELDS DR",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208173573",
            "telephone_number": "301-363-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 SHIELDS DR",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208173573",
            "telephone_number": "301-363-9026",
            "fax_number": "301-363-9669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DC PEDIATRIC SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-363-9026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.