Healthcare Provider Details

I. General information

NPI: 1720617392
Provider Name (Legal Business Name): MY SMILE EXPERIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ROCKINGHAM RD
WINDHAM NH
03087-1360
US

IV. Provider business mailing address

341 SUMMER ST STE 1
SOMERVILLE MA
02144-3141
US

V. Phone/Fax

Practice location:
  • Phone: 603-485-0024
  • Fax:
Mailing address:
  • Phone: 617-625-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMED HANIF BUTT
Title or Position: PRESIDENT
Credential: DMD
Phone: 603-485-0024