Healthcare Provider Details

I. General information

NPI: 1700538568
Provider Name (Legal Business Name): EVERETT SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 VICTORIA ST
EVERETT MA
02149-3511
US

IV. Provider business mailing address

534 COMMONWEALTH AVE APT 4A
BOSTON MA
02215-2604
US

V. Phone/Fax

Practice location:
  • Phone: 617-889-5437
  • Fax:
Mailing address:
  • Phone: 617-501-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. VANDANA SONI
Title or Position: DIRECTOR
Credential: DMD
Phone: 617-889-5437