Provider Demographics
NPI:1639473945
Name:SMILE WIDER PC
Entity Type:Organization
Organization Name:SMILE WIDER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAWAF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-212-0588
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-0004
Mailing Address - Country:US
Mailing Address - Phone:617-323-1966
Mailing Address - Fax:401-949-4618
Practice Address - Street 1:26 CUMMINS HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2515
Practice Address - Country:US
Practice Address - Phone:617-323-1966
Practice Address - Fax:401-949-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty