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General NPI Number Information
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NPI Number | 1265760193
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Entity Type | Organization
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Legal Business Name | SMILE DENTAL & DENTURES P.C.
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 400 LINCOLN ST. SUITE 21
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City | HINGHAM
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State | MA
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Zip | 02043-3461
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Country | US
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Telephone | 781-836-5230
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Fax |
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Provider Business Mailing Address
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Address Line | 400 LINCOLN ST. SUITE 21
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City | HINGHAM
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State | MA
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Zip | 02043-3461
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Country | US
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Telephone | 781-836-5230
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER J. MORTELLITI
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Credential | D.D.S.
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Telephone | 781-836-5230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13263
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License Number State | MA
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