Kim Shopp Haskell, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

07923 Issued in MD

Practice address

14414 Old Mill Rd
#101
Upper Marlboro, MD 20772-3069

Phone

(301) 627-6646

Fax

(301) 627-4996

NPI assigned

Nov 14, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sculpted Smiles

  • Dental Clinic/Center
  • Upper Marlboro, MD
  • NPI 1083418438
  NPD (past)

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453075200000",
    "number": "1780865147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14414 OLD MILL RD",
            "address_2": "#101",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723069",
            "telephone_number": "301-627-6646",
            "fax_number": "301-627-4996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14414 OLD MILL RD",
            "address_2": "#101",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723069",
            "telephone_number": "301-627-6646",
            "fax_number": "301-627-4996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKELL",
        "first_name": "KIM",
        "middle_name": "SHOPP",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2016-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "07923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willa Bella Harris
• Amanda M Harrison
• Ciara O Harrison, BEHAVIOR TECHNICIAN
• Michelle D Harvey, PHARMD
• Sonia Reeves Harvey, LCSW
• Tyrisha Alexis Haskins
• Danielle Hatchell, LCPC
• Bryan Haverly, RMP
• Abria Hawkins
• Alicia M Hawkins

• Dentist in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.