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General NPI Number Information
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NPI Number | 1770185324
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Entity Type | Organization
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Legal Business Name | SMILECARE DENTAL OF FITCHBURG PC
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 164 ELM ST
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City | FITCHBURG
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State | MA
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Zip | 01420-3192
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Country | US
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Telephone | 978-345-5563
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Fax |
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Provider Business Mailing Address
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Address Line | 24 DEWEY RD
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City | LEXINGTON
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State | MA
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Zip | 02420-1018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KADAMBARI GLEN COLACO
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Credential |
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Telephone | 716-541-4566
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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 |
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License Number State |
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