NPI 1831766211 · live from the CMS NPI Registry
Broad Smiles LLC
Dentist, Pediatric Dentistry in Salem, MA. National Provider Identifier 1831766211, active.
NPI record
| NPI | 1831766211 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Pediatric Dentistry 1223P0221X |
| Practice location | 600 Loring Ave Ste 8, Salem, MA 01970 |
| Practice phone | 978-910-0004 |
| Enumerated | June 5, 2021 |
| Last updated | June 5, 2021 |
| Authorized official | Hubert Park, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | — |
| Dentist, Pediatric Dentistry primary | 1223P0221X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.