Provider Demographics
NPI:1679376230
Name:PERLA PEDIATRIC SMILES
Entity type:Organization
Organization Name:PERLA PEDIATRIC SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NILOUFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAZINIYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-707-7207
Mailing Address - Street 1:200 ESTATE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3538
Mailing Address - Country:US
Mailing Address - Phone:857-707-7207
Mailing Address - Fax:617-912-5603
Practice Address - Street 1:70 HASTINGS ST STE 103
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5439
Practice Address - Country:US
Practice Address - Phone:617-420-1616
Practice Address - Fax:617-912-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty