NPIMap

Organization Active NPI

Smalltowne Dental LLC

  • Dental Clinic/Center
  • La Plata, MD
National Provider Identifier
1306642848
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SMALLTOWNE DENTAL LLC
Practice address
6620 Crain Hwy Ste 204
La Plata, MD 20646-4273
Phone
(301) 870-3966
Fax
(301) 753-1992
NPI assigned
Feb 24, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Dr. Demion Cornwall, DDSNPI 1982965711
Title
Owner
Phone
(646) 436-2195

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

6620 Crain Hwy Ste 204
La Plata, MD 20646-4273

Mailing address

6620 Crain Hwy Ste 204
La Plata, MD 20646-4273
Phone (301) 870-3966

National Provider Directory

National Provider Directory

Locations

6620 Crain Hwy
Ste 204
La Plata, MD 20646
Phone (301) 870-3966

Practitioners & affiliated clinicians

Practitioners 3

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": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1306642848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 CRAIN HWY STE 204",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206464273",
            "telephone_number": "301-870-3966",
            "fax_number": "301-753-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 CRAIN HWY STE 204",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206464273",
            "telephone_number": "301-870-3966",
            "fax_number": "301-753-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMALLTOWNE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "CORNWALL",
        "authorized_official_first_name": "DEMION",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-436-2195",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.