| Mattapan Smiles Youth Dentistry, Llc | |
|
90 River St Mattapan MA 02126-2914 | |
| (617) 698-5437 | |
| (617) 698-5435 |
| Full Name | Mattapan Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 90 River St, Mattapan, Massachusetts |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mattapan Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Mattapan Smiles Youth Dentistry, Llc 90 River St Mattapan MA 02126-2914 Ph: (617) 698-5437 |
| NPI Number | 1619065901 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619065901 | NPI | - | NPPES |
| 110070846A | Medicaid | MA | |
| 9753231 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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