Brockton Smiles Youth Dentistry, Llc

LBN: Brockton Smiles Youth Dentistry, Llc
Brockton Smiles Youth Dentistry, Llc is an health care organization with primary practice located at 70 Westgate Dr , Brockton MA 02301-1811. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. Brockton Smiles Youth Dentistry, Llc can be contacted via phone (508) 588-8090, or through Stump, Jenell via phone (615) 750-0343.

Contact Information

Primary practice address
70 Westgate Dr Brockton MA 02301-1811
Phone: (508) 588-8090
Fax: (508) 588-8010
Website:
Map and Directions
Authorized official contact:
Name: Stump, Jenell
Phone: (615) 750-0343

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X

Profile Details

NPI number 1851581243
LBN Legal business name Brockton Smiles Youth Dentistry, Llc
DBA Doing business as
Authorized official Stump, Jenell
Entity Organization
Organization subpart 1 No
Enumeration date Jul 31st, 2007
Last updated Jul 9th, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851581243 NPPES
Massachusetts MEDICAID 110077842A

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