NPIMap

Organization Active NPI

PGN Dental LLC

Doing business as Elegant Smiles Dentistry

  • Dental Clinic/Center
  • Upper Marlboro, MD
National Provider Identifier
1295279024
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PGN DENTAL LLC
Doing business as
Elegant Smiles Dentistry
Practice address
14420 Old Mill Rd Ste 101
Upper Marlboro, MD 20772-3096
Phone
(301) 627-6686
NPI assigned
Dec 13, 2016
Last updated
Aug 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Authorized official

Name
Dawn Berezoski
Title
Reception/Financial
Phone
(301) 627-6687

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary
General Practice Dentistry 1223G0001X 14871 MD

Addresses

Primary practice location

14420 Old Mill Rd Ste 101
Upper Marlboro, MD 20772-3096

Mailing address

14420 Old Mill Rd Ste 101
Upper Marlboro, MD 20772-3096
Phone (301) 627-6686

Other names 1

  • Elegant Smiles Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1295279024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14420 OLD MILL RD STE 101",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723096",
            "telephone_number": "301-627-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14420 OLD MILL RD STE 101",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723096",
            "telephone_number": "301-627-6686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PGN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-13",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "BEREZOSKI",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "RECEPTION/FINANCIAL",
        "authorized_official_telephone_number": "301-627-6687"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "14871",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elegant Smiles Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.