Healthcare Provider Details

I. General information

NPI: 1821584103
Provider Name (Legal Business Name): SMILEY DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BERDON WAY
FAIRHEAVEN MA
02719
US

IV. Provider business mailing address

17 BERDON WAY
FAIRHEAVEN MA
02719
US

V. Phone/Fax

Practice location:
  • Phone: 508-444-0110
  • Fax:
Mailing address:
  • Phone: 508-444-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APARNA KHANNA
Title or Position: OWNER
Credential:
Phone: 617-335-1167