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General NPI Number Information
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NPI Number | 1407192164
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Entity Type | Organization
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Legal Business Name | MEDFIELD SMILES PC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 16 PARK ST
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City | MEDFIELD
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State | MA
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Zip | 02052-2518
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Country | US
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Telephone | 508-359-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 2 SNOW HILL LN
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City | MEDFIELD
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State | MA
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Zip | 02052-1322
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Country | US
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Telephone | 508-596-0297
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEAN RAYMENT
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Credential | D.M.D.
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Telephone | 508-596-0297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN19355
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License Number State | MA
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