Healthcare Provider Details

I. General information

NPI: 1073452066
Provider Name (Legal Business Name): EXCELLENCE DENTAL ESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 HIGHLAND AVE STE 203
NEEDHAM MA
02492-2617
US

IV. Provider business mailing address

1410 HIGHLAND AVE STE 203
NEEDHAM MA
02492-2617
US

V. Phone/Fax

Practice location:
  • Phone: 857-540-8367
  • Fax:
Mailing address:
  • Phone: 857-540-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: EVIS MYFTIU
Title or Position: PROVIDER / OWNER
Credential: DMD
Phone: 857-558-3507