Provider Demographics
NPI:1356848402
Name:NORTH BILLERICA SMILES, LLC.
Entity Type:Organization
Organization Name:NORTH BILLERICA SMILES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ANNESE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-804-3641
Mailing Address - Street 1:45 DERBY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3038
Mailing Address - Country:US
Mailing Address - Phone:978-804-3641
Mailing Address - Fax:978-425-4503
Practice Address - Street 1:315 BOSTON RD
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2635
Practice Address - Country:US
Practice Address - Phone:978-804-3641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856006261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental