Organization Active NPI

Smile Loft Gaithersburg LLC

  • General Practice Dentistry
  • Gaithersburg, MD
National Provider Identifier
1154917904
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SMILE LOFT GAITHERSBURG LLC
Practice address
9069 Shady Grove CT
Gaithersburg, MD 20877-1301
Phone
(301) 977-3766
NPI assigned
Dec 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Authorized official

Name
Christine Rai
Title
HR Director
Phone
(410) 610-3071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

9069 Shady Grove CT
Gaithersburg, MD 20877-1301

Mailing address

9069 Shady Grove CT
Gaithersburg, MD 20877-1301
Phone (301) 977-3766

Other identifiers 1

IdentifierTypeStateIssuer
046068200MedicaidMD

National Provider Directory

National Provider Directory

Locations

9069 Shady Grove Ct
Gaithersburg, MD 20877
Phone (301) 977-3766

Practitioners & affiliated clinicians

Practitioners 2

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": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1154917904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9069 SHADY GROVE CT",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771301",
            "telephone_number": "301-977-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9069 SHADY GROVE CT",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771301",
            "telephone_number": "301-977-3766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE LOFT GAITHERSBURG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "RAI",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "410-610-3071"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046068200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.