NPIMap

Organization Active NPI

Super Kids Teeth LLC

Doing business as Severn Pediatric Dentistry

  • Pediatric Dentistry
  • Odenton, MD
National Provider Identifier
1376065193
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SUPER KIDS TEETH LLC
Doing business as
Severn Pediatric Dentistry
Practice address
2288 Blue Water Blvd Ste 328
Odenton, MD 21113-3309
Phone
(410) 995-8000
NPI assigned
Jul 13, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Soe T MonNPI 1306106091
Title
Co-Owner
Phone
(410) 995-8000

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 Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

2288 Blue Water Blvd Ste 328
Odenton, MD 21113-3309

Mailing address

2288 Blue Water Blvd Ste 328
Odenton, MD 21113-3309
Phone (410) 995-8000

Other identifiers 1

IdentifierTypeStateIssuer
59291MedicaidMD

Other names 1

  • Severn Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2288 Blue Water Blvd
Ste 328
Odenton, MD 21113
Phone (410) 995-8000

Practitioners & affiliated clinicians

Practitioners 1

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": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1376065193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2288 BLUE WATER BLVD STE 328",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211133309",
            "telephone_number": "410-995-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2288 BLUE WATER BLVD STE 328",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211133309",
            "telephone_number": "410-995-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER KIDS TEETH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MON",
        "authorized_official_first_name": "SOE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "410-995-8000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59291",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Severn Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odenton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.