Provider Demographics
NPI:1437426475
Name:NEW SMILE FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:NEW SMILE FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-481-9004
Mailing Address - Street 1:62 MONTVALE AVE
Mailing Address - Street 2:K
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:62 MONTVALE AVE
Practice Address - Street 2:K
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3637
Practice Address - Country:US
Practice Address - Phone:781-481-9004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18554321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty