Provider Demographics
NPI:1659547198
Name:HEALTHY SMILES PC
Entity Type:Organization
Organization Name:HEALTHY SMILES PC
Other - Org Name:HEALTHY SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-894-8100
Mailing Address - Street 1:345 W CENTER ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379
Mailing Address - Country:US
Mailing Address - Phone:508-894-8100
Mailing Address - Fax:508-894-8101
Practice Address - Street 1:345 W CENTER ST
Practice Address - Street 2:STE 1
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1600
Practice Address - Country:US
Practice Address - Phone:508-894-8100
Practice Address - Fax:508-894-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20277122300000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty