NPIMap

Organization Active NPI

Edmondson Dental Center for Maryland Public Health, Inc

  • General Practice Dentistry
  • Grantsville, MD
National Provider Identifier
1821384314
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13821 Issued in MD
Legal business name
EDMONDSON DENTAL CENTER FOR MARYLAND PUBLIC HEALTH, INC
Doing business as
Pampered Smiles Dental Day Spa (D.D.S.)
Practice address
170 Miller St
Grantsville, MD 21536-1383
Phone
(301) 895-5780
NPI assigned
Jun 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Dr. C.W. Edmondson, D.D.S.NPI 1497727754
Title
President
Phone
(301) 895-5780

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 13821 MD Primary

Addresses

Primary practice location

170 Miller St
Grantsville, MD 21536-1383

Mailing address

170 Miller St
Grantsville, MD 21536-1383
Phone (301) 895-5780

Other identifiers 1

IdentifierTypeStateIssuer
039320700MedicaidMD

Other names 1

  • Pampered Smiles Dental Day Spa (D.D.S.) Doing business as

National Provider Directory

National Provider Directory

Locations

170 Miller St
Grantsville, MD 21536
Phone (301) 895-5780

Practitioners & affiliated clinicians

Practitioners 1

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": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1821384314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 MILLER ST",
            "city": "GRANTSVILLE",
            "state": "MD",
            "postal_code": "215361383",
            "telephone_number": "301-895-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MILLER ST",
            "city": "GRANTSVILLE",
            "state": "MD",
            "postal_code": "215361383",
            "telephone_number": "301-895-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMONDSON DENTAL CENTER FOR MARYLAND PUBLIC HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "C.W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-895-5780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039320700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pampered Smiles Dental Day Spa (D.D.S.)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grantsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.