Provider Demographics
NPI:1215290606
Name:MASS HEALTHY SMILES, LLC
Entity type:Organization
Organization Name:MASS HEALTHY SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:508-245-8164
Mailing Address - Street 1:19 GREEN LEAF RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2154
Mailing Address - Country:US
Mailing Address - Phone:508-245-8164
Mailing Address - Fax:508-697-9117
Practice Address - Street 1:19 GREEN LEAF RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2154
Practice Address - Country:US
Practice Address - Phone:508-245-8164
Practice Address - Fax:508-697-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty