Provider Demographics
NPI:1881200822
Name:SQUARE SMILES, PC
Entity Type:Organization
Organization Name:SQUARE SMILES, PC
Other - Org Name:EAST MILTON ORTHODONTICS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEXIS
Authorized Official - Middle Name:ELON
Authorized Official - Last Name:JOFFRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-898-0220
Mailing Address - Street 1:25 BRYANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 BRYANT AVENUE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-533-8058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty