Provider Demographics
NPI:1700538568
Name:EVERETT SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS PC
Entity Type:Organization
Organization Name:EVERETT SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-889-5437
Mailing Address - Street 1:534 COMMONWEALTH AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2604
Mailing Address - Country:US
Mailing Address - Phone:617-501-7773
Mailing Address - Fax:
Practice Address - Street 1:11 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3511
Practice Address - Country:US
Practice Address - Phone:617-889-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty