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General NPI Number Information
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NPI Number | 1225725286
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Entity Type | Organization
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Legal Business Name | GREATER BOSTON SMILES PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 300 CROWN COLONY DR STE 203
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City | QUINCY
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State | MA
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Zip | 02169-0929
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Country | US
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Telephone | 617-472-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 240 DEVONSHIRE ST UNIT 4501
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City | BOSTON
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State | MA
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Zip | 02110-2172
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Country | US
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Telephone | 617-678-3125
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZACHARY KOFOS
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Credential | DMD
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Telephone | 617-678-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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