Healthcare Provider Details

I. General information

NPI: 1063336444
Provider Name (Legal Business Name): NORTH SHORE SMILE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 BURRILL ST
SWAMPSCOTT MA
01907-1808
US

IV. Provider business mailing address

128 BURRILL ST
SWAMPSCOTT MA
01907-1808
US

V. Phone/Fax

Practice location:
  • Phone: 781-552-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAD HENDRICKS
Title or Position: CREDENTIALING
Credential:
Phone: 612-859-0444