Provider Demographics
NPI:1255501532
Name:ENDLESS SMILE FAMILY DENTAL CENTER LLC
Entity Type:Organization
Organization Name:ENDLESS SMILE FAMILY DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:MAHDI
Authorized Official - Last Name:ELFAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-622-6446
Mailing Address - Street 1:PO BOX 16336
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-6336
Mailing Address - Country:US
Mailing Address - Phone:603-622-6446
Mailing Address - Fax:
Practice Address - Street 1:45 LONDON DERRY TURNPIKE
Practice Address - Street 2:SUITE #3
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106
Practice Address - Country:US
Practice Address - Phone:603-622-6446
Practice Address - Fax:603-622-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty