Provider Demographics
NPI:1982178281
Name:RANDOLPH DENTAL SMILE PLLC
Entity Type:Organization
Organization Name:RANDOLPH DENTAL SMILE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-526-5042
Mailing Address - Street 1:3 JAMIE LN
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6319
Mailing Address - Country:US
Mailing Address - Phone:781-526-5042
Mailing Address - Fax:
Practice Address - Street 1:89 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4896
Practice Address - Country:US
Practice Address - Phone:781-963-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty