Healthcare Provider Details

I. General information

NPI: 1336150697
Provider Name (Legal Business Name): SMART DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CHESTNUT ST
ARLINGTON MA
02474
US

IV. Provider business mailing address

19 CHESTNUT ST
ARLINGTON MA
02474
US

V. Phone/Fax

Practice location:
  • Phone: 781-643-2344
  • Fax: 781-641-3483
Mailing address:
  • Phone: 781-643-2344
  • Fax: 781-641-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MAGED A EL-MALECKI
Title or Position: OWNER/PRESIDENT
Credential: D.M.D.
Phone: 617-548-8003