Provider Demographics
NPI:1811213093
Name:FUTURE SMILES OF AMERICA
Entity Type:Organization
Organization Name:FUTURE SMILES OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAHLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-609-0404
Mailing Address - Street 1:226 WINCHESTER ST
Mailing Address - Street 2:2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2767
Mailing Address - Country:US
Mailing Address - Phone:617-906-0404
Mailing Address - Fax:617-906-5403
Practice Address - Street 1:226 WINCHESTER ST
Practice Address - Street 2:2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2767
Practice Address - Country:US
Practice Address - Phone:617-906-0404
Practice Address - Fax:617-906-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21838261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99034028Medicaid