NPIMap

Organization Active NPI

Simple Miracles Dentistry, LLC

  • General Practice Dentistry
  • Bowie, MD
National Provider Identifier
1952189136
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SIMPLE MIRACLES DENTISTRY, LLC
Practice address
16900 Science Dr Ste 110
Bowie, MD 20715-4465
Phone
(301) 383-0958
Fax
(240) 487-5161
NPI assigned
Sep 19, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Authorized official

Name
Dr. Shana A DicksNPI 1588004485
Title
General Dentist
Phone
(301) 383-0958

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 Primary

Addresses

Primary practice location

16900 Science Dr Ste 110
Bowie, MD 20715-4465

Mailing address

16900 Science Dr Ste 110
Bowie, MD 20715-4465
Phone (301) 383-0958

National Provider Directory

National Provider Directory

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": "1695081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1952189136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16900 SCIENCE DR STE 110",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207154465",
            "telephone_number": "301-383-0958",
            "fax_number": "240-487-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16900 SCIENCE DR STE 110",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207154465",
            "telephone_number": "301-383-0958",
            "fax_number": "240-487-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLE MIRACLES DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "DICKS",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "301-383-0958",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.