Provider Demographics
NPI:1205318714
Name:ACTON SMILE HUB PC
Entity type:Organization
Organization Name:ACTON SMILE HUB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUFA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-263-7703
Mailing Address - Street 1:418 MASSACHUSETTS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3723
Mailing Address - Country:US
Mailing Address - Phone:978-263-7703
Mailing Address - Fax:
Practice Address - Street 1:418 MASSACHUSETTS AVE STE 3
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3723
Practice Address - Country:US
Practice Address - Phone:207-518-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental