Provider Demographics
NPI:1114781150
Name:SMILE ORTHODONTICS, P.C.
Entity Type:Organization
Organization Name:SMILE ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORINA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:857-200-8323
Mailing Address - Street 1:55 WEST ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5651
Mailing Address - Country:US
Mailing Address - Phone:978-534-0173
Mailing Address - Fax:978-534-1130
Practice Address - Street 1:55 WEST ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5651
Practice Address - Country:US
Practice Address - Phone:978-534-0173
Practice Address - Fax:978-534-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty