NPIMap

Organization Active NPI

Waverly Woods Aesthetic Dental

  • Dental Clinic/Center
  • Marriottsville, MD
National Provider Identifier
1881366276
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
WAVERLY WOODS AESTHETIC DENTAL
Practice address
2600 Longstone LN Ste 101
Marriottsville, MD 21104-1530
Phone
(410) 442-0103
NPI assigned
Oct 4, 2021
Last updated
Oct 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Authorized official

Name
Christine M Snyder, FAADOM
Title
Office Manager
Phone
(410) 442-0103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2600 Longstone LN Ste 101
Marriottsville, MD 21104-1530

Mailing address

2600 Longstone LN Ste 101
Marriottsville, MD 21104-1530
Phone (410) 442-0103

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL OFFICE@REVIVESMILE.COM

National Provider Directory

National Provider Directory

Locations

2600 Longstone Ln
Ste 101
Marriottsville, MD 21104
Phone (410) 442-0103

Practitioners & affiliated clinicians

Practitioners 3

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": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1881366276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 LONGSTONE LN STE 101",
            "city": "MARRIOTTSVILLE",
            "state": "MD",
            "postal_code": "211041530",
            "telephone_number": "410-442-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 LONGSTONE LN STE 101",
            "city": "MARRIOTTSVILLE",
            "state": "MD",
            "postal_code": "211041530",
            "telephone_number": "410-442-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY WOODS AESTHETIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "SNYDER",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "410-442-0103",
        "authorized_official_credential": "FAADOM"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "OFFICE@REVIVESMILE.COM",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "address_1": "2600 Longstone Ln Ste 101",
            "city": "Marriottsville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "211041530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marriottsville, MD

Sources for this page

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