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General NPI Number Information
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NPI Number | 1568832673
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Entity Type | Organization
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Legal Business Name | A BEAUTIFUL SMILE DENTISTRY LLC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 1864 CENTRE ST SUITE 1
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1919
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Country | US
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Telephone | 617-390-5371
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Fax |
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Provider Business Mailing Address
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Address Line | 1864 CENTRE ST SUITE 1
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1919
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Country | US
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Telephone | 617-390-5371
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. DAVID JIN
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Credential | DDS
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Telephone | 617-390-5371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN1856750
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License Number State | MA
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