Provider Demographics
NPI:1336487883
Name:Q SMILE PC
Entity Type:Organization
Organization Name:Q SMILE PC
Other - Org Name:Q SMILE DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANHPHI
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-479-8400
Mailing Address - Street 1:235 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6754
Mailing Address - Country:US
Mailing Address - Phone:617-479-8400
Mailing Address - Fax:617-479-8450
Practice Address - Street 1:235 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6754
Practice Address - Country:US
Practice Address - Phone:617-479-8400
Practice Address - Fax:617-479-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21968261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental