Provider Demographics
NPI:1265150106
Name:SMYTH, ELAINE (BA, BDENTSC, DCHDENT)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:SMYTH
Suffix:
Gender:F
Credentials:BA, BDENTSC, DCHDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:DENTISTRY MAILSTOP 3071
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-919-1779
Mailing Address - Fax:617-730-0478
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:DENTISTRY MAILSTOP 3071
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-919-1779
Practice Address - Fax:617-730-0478
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL151601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry