Provider Demographics
NPI:1770185324
Name:SMILECARE DENTAL OF FITCHBURG PC
Entity Type:Organization
Organization Name:SMILECARE DENTAL OF FITCHBURG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KADAMBARI
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:COLACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-541-4566
Mailing Address - Street 1:24 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:164 ELM ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3192
Practice Address - Country:US
Practice Address - Phone:978-345-5563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty