NPIMap

Organization Active NPI

Confident Smiles of Waldorf LLC

  • Dental Clinic/Center
  • Waldorf, MD
National Provider Identifier
1740777325
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
15394 Issued in MD
Legal business name
CONFIDENT SMILES OF WALDORF LLC
Practice address
11865 Federal SQ Ste 102
Waldorf, MD 20602-3226
Phone
(301) 645-2211
NPI assigned
Apr 18, 2018
Last updated
Apr 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Dr. Qasiym Gilliam, DDSNPI 1558780254
Title
Owner
Phone
(301) 843-0277

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 15394 MD Primary

Addresses

Primary practice location

11865 Federal SQ Ste 102
Waldorf, MD 20602-3226

Mailing address

11865 Federal SQ Ste 102
Waldorf, MD 20602-3226
Phone (301) 645-2211

National Provider Directory

National Provider Directory

Locations

11865 Federal Sq
Ste 102
Waldorf, MD 20602
Phone (301) 645-2211

Practitioners & affiliated clinicians

Practitioners 4

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": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1740777325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11865 FEDERAL SQ STE 102",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023226",
            "telephone_number": "301-645-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11865 FEDERAL SQ STE 102",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023226",
            "telephone_number": "301-645-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONFIDENT SMILES OF WALDORF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-18",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "QASIYM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-843-0277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MD",
            "license": "15394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; 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.