Provider Demographics
NPI:1316361371
Name:DAZZLING SMILE CARE
Entity Type:Organization
Organization Name:DAZZLING SMILE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAJARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-773-6605
Mailing Address - Street 1:522 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:WOLLASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1921
Mailing Address - Country:US
Mailing Address - Phone:617-773-6605
Mailing Address - Fax:617-773-6606
Practice Address - Street 1:522 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:WOLLASTON
Practice Address - State:MA
Practice Address - Zip Code:02170-1921
Practice Address - Country:US
Practice Address - Phone:617-773-6605
Practice Address - Fax:617-773-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty