Provider Demographics
NPI:1053618140
Name:SMILE DENTAL, PC
Entity type:Organization
Organization Name:SMILE DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-284-2275
Mailing Address - Street 1:144 BROADWAY # 2
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5349
Mailing Address - Country:US
Mailing Address - Phone:781-284-2275
Mailing Address - Fax:781-426-7614
Practice Address - Street 1:144 BROADWAY # 2
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5349
Practice Address - Country:US
Practice Address - Phone:781-284-2275
Practice Address - Fax:781-426-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN190441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty