Provider Demographics
NPI:1205213774
Name:SMILEBOSTON COSMETIC AND IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:SMILEBOSTON COSMETIC AND IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-277-4100
Mailing Address - Street 1:1180 BEACONSTREET SUITE 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-277-4100
Mailing Address - Fax:617-277-4100
Practice Address - Street 1:1180 BEACON ST STE 2B
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3806
Practice Address - Country:US
Practice Address - Phone:617-277-4100
Practice Address - Fax:617-277-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18722305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization