Provider Demographics
NPI:1164293163
Name:SUDBURY ELITE SMILES PC
Entity Type:Organization
Organization Name:SUDBURY ELITE SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZAVETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALININA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-443-5500
Mailing Address - Street 1:200 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2352
Mailing Address - Country:US
Mailing Address - Phone:978-443-6081
Mailing Address - Fax:
Practice Address - Street 1:200 CONCORD RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2352
Practice Address - Country:US
Practice Address - Phone:978-443-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty