Provider Demographics
NPI:1154818359
Name:LEXINGTON SMILE STUDIO, PC
Entity Type:Organization
Organization Name:LEXINGTON SMILE STUDIO, PC
Other - Org Name:LEXINGTON SMILE STUDIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAAEDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWAZZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-669-9839
Mailing Address - Street 1:500 ATLANTIC AVE UNIT 14K
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2245
Mailing Address - Country:US
Mailing Address - Phone:176-699-8396
Mailing Address - Fax:
Practice Address - Street 1:922 WALTHAM ST STE 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8019
Practice Address - Country:US
Practice Address - Phone:781-861-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty