LAUREL LAKES PEDIATRIC DENTISTRY, LLC (NPI# 1649717638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649717638 |
| Entity Type | Organization |
| Organization Name | LAUREL LAKES PEDIATRIC DENTISTRY, LLC |
| Other Organization Name | LAUREL LAKES PEDIATRIC DENTISTRY |
| Practice Address |
13964 Baltimore Ave Suite C6 Laurel MD 20707 |
| Mailing Address |
401 Church St Suite 2210 Nashville TN 37219-2310 |
| Practice Telephone | 2022760649 |
| Practice Fax Number | 6318577860 |
| Mailing Telephone | 6159882627 |
| Mailing Fax Number | 6318577860 |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2018-07-20 |
| Authorized Official Name | ANTIONETTE C. WILSON (OWNER) |
| Authorized Official Telephone | 2022760649 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
13970 | MD | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | DENTAL LICENSE | 13970 | 01 |
| Other Name | Type Code |
|---|---|
| Laurel Lakes Pediatric Dentistry | Doing Business As Name - Organization |
| Street Address |
13964 BALTIMORE AVE SUITE C6 |
| City | LAUREL |
| State | MD |
| Zip Code | 20707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376157156 | Mini'imah Wilson | Social Worker | 15041 Cherrywood Dr, Laurel, MD 20707 | 2020-08-31 |
| 1548893985 | Ernest Freeman | Clinic/Center | 367 Main St., Laurel, Laurel, MD 20707 | 2020-02-13 |
| 1538701859 | Family Health and Wellness Clinic LLC | Clinic/Center | 324 Main St. #523, Laurel, MD 20707 | 2019-10-09 |
| 1467018226 | Leena Daniel | Nurse Practitioner | 13 C Street, Suite D, Laurel, MD 20707 | 2019-05-16 |
| 1538723143 | Florence Okojie | Nurse Practitioner | 13 C St Ste G, Laurel, MD 20707 | 2019-04-29 |
| 1487148631 | Munsha Sidhu Chadha | Dentist | 595 Main St Ste 237, Laurel, MD 20707 | 2018-06-20 |
| 1568953370 | Carleen Graham Schwimmer | Clinical Neuropsychologist | Veterans Affairs War Related Illness & Injury (wriisc), 50 Irving Street Nw, Washington, MD 20707 | 2018-05-29 |
| 1043709637 | Bk Behavioral Health Center | Behavior Technician | 14300 Cherry Lane Ct Ste 202-203, Laurel, MD 20707 | 2018-05-09 |
| 1053800839 | Bk Behaviorial Health Center | Substance Abuse Rehabilitation Facility | 14300 Cherry Lane Court, Suite 202-203, Laurel, MD 20707 | 2018-05-07 |
| 1316435795 | Laurel Pharmacy II LLC | Pharmacy | 14402 Baltimore Ave, Laurel, MD 20707 | 2018-05-01 |
| Find all providers in zip 20707 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1518194901 | Adrian Johnston Wilson | Dentist | 14300 Ridge View Ln, Laurel, MD 20707-6278 | 2009-06-12 |
| 1053715268 | Laurel Pediatric Dentistry | Dentist | 13916 Baltimore Ave, Laurel, MD 20707-5009 | 2014-10-17 |
| 1982609624 | James Paul Goldsmith | Dentist | 14333 Laurel Bowie Rd, Ste 301, Laurel, MD 20708-1183 | 2005-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295385698 | Just 4 Kidz Dentistry, LLC | Dentist | 12250 Rockville Pike Ste 200, Rockville, MD 20852-1669 | 2019-09-17 |
| 1033761960 | Caroline Larosiliere Dds and Associates | Dentist | 10605 Greenbelt Rd, Lanham, MD 20706-2274 | 2019-07-11 |
| 1720562507 | Arundel Pediatric Dental Care | Dentist | 8531 Veterans Hwy Ste 103, Millersville, MD 21108-2653 | 2018-09-18 |
| 1083192884 | Chang & Phan Dental, LLC | Dentist | 451 Hungerford Dr Ste 100, Rockville, MD 20850-5102 | 2018-08-02 |
| 1710473731 | Marlborough Village Pediatric Dental | Dentist | 5098 Brown Station Rd Ste 260, Upper Marlboro, MD 20772-9124 | 2018-07-02 |
| 1184116618 | Kiddie Cavity Care Thmd, LLC | Dentist | 3743 Branch Ave Ste A, Temple Hills, MD 20748-1408 | 2018-05-31 |
| 1851881999 | Haider Alshami | Dentist | 650 W Baltimore St, Baltimore, Md 21201, 3rd Flood, Baltimore, MD 21286 | 2018-05-15 |
| 1306335468 | Adam Elrafei | Dentist | 2 Hamill Rd Ste 266, Baltimore, MD 21210-1894 | 2018-05-04 |
| 1285121137 | Zamora Kids Dentistry, P.a. | Dentist | 1350 Blair Dr Ste I, Odenton, MD 21113-1333 | 2018-04-17 |
| 1336659721 | Tyson Bross Dmd Phd LLC | Dentist | 129 Lubrano Dr Ste 300, Annapolis, MD 21401-7568 | 2017-10-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.