| Broad Smiles LLC | |
|
600 Loring Ave Ste 8 Salem MA 01970-4264 | |
| (978) 910-0004 | |
| Not Available |
| Full Name | Broad Smiles LLC |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 600 Loring Ave Ste 8, Salem, Massachusetts |
| Authorized Official Name and Position | Hubert J Park (PRESIDENT) |
| Authorized Official Contact | 6178956700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broad Smiles LLC 600 Loring Ave Ste 8 Salem MA 01970-4264 Ph: (978) 910-0004 | Broad Smiles LLC 600 Loring Ave Ste 8 Salem MA 01970-4264 Ph: (978) 910-0004 |
| NPI Number | 1831766211 |
|---|---|
| Provider Enumeration Date | 06/05/2021 |
| Last Update Date | 06/05/2021 |
| Certification Date | 06/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831766211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | () | Secondary |
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