Healthcare Provider Details

I. General information

NPI: 1760936231
Provider Name (Legal Business Name): SMF1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 POND ST
ASHLAND MA
01721-2054
US

IV. Provider business mailing address

39 POND ST
ASHLAND MA
01721-2054
US

V. Phone/Fax

Practice location:
  • Phone: 617-293-4821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. ANAND DHINGRA
Title or Position: OFFICE MANAGER
Credential:
Phone: 617-293-4821