Healthcare Provider Details

I. General information

NPI: 1548903909
Provider Name (Legal Business Name): SMILE SOLUTION SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 BEACON ST STE 409
BROOKLINE MA
02446-5622
US

IV. Provider business mailing address

1051 BEACON ST STE 409
BROOKLINE MA
02446-5622
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-0033
  • Fax:
Mailing address:
  • Phone: 617-277-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: GLORIA BARZI
Title or Position: PRESIDENT
Credential: DMD
Phone: 617-277-0033