Champion Smiles of Maryland LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

CHAMPION SMILES OF MARYLAND LLC

Practice address

113 La Grange Ave
La Plata, MD 20646-9592

Phone

(301) 249-4123

NPI assigned

Mar 4, 2021

Last updated

Mar 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amber Gibbs

Title

Practice Manager

Phone

(301) 249-4123

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1396330049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2768",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206462768",
            "telephone_number": "301-249-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LA GRANGE AVE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206469592",
            "telephone_number": "301-249-4123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9616 Marlboro Pike",
            "address_purpose": "LOCATION",
            "city": "Upper Marlboro",
            "state": "MD",
            "postal_code": "20772",
            "country_code": "US",
            "telephone_number": "301-249-4123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10905 Fort Washington Rd Ste 302",
            "address_purpose": "LOCATION",
            "city": "Ft Washington",
            "state": "MD",
            "postal_code": "207445812",
            "country_code": "US",
            "telephone_number": "301-249-4123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHAMPION SMILES OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "301-249-4123"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054215600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in La Plata, MD
• Providers in La Plata, MD by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.