Healthcare Provider Details

I. General information

NPI: 1164077152
Provider Name (Legal Business Name): NORTH SHORE SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 HUMPHREY STR.
SWAMPSCOTT MA
01907
US

IV. Provider business mailing address

293 HUMPHREY STR.
SWAMPSCOTT MA
01907
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-8300
  • Fax: 781-593-5440
Mailing address:
  • Phone: 781-599-8300
  • Fax: 781-593-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY J. FEIDER
Title or Position: OWNER
Credential: D.M.D.
Phone: 781-599-8300