NPIMap

Organization Active NPI

Smile Dental, PC

  • General Practice Dentistry
  • Revere, MA
National Provider Identifier
1053618140
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN19044 Issued in MA
Legal business name
SMILE DENTAL, PC
Doing business as
broadway dental
Practice address
144 Broadway # 2
Revere, MA 02151-5349
Phone
(781) 284-2275
Fax
(781) 426-7614
NPI assigned
Feb 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bella Ostrovsky
Title
Manager
Phone
(781) 284-2275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN19044 MA Primary

Addresses

Primary practice location

144 Broadway # 2
Revere, MA 02151-5349

Mailing address

144 Broadway # 2
Revere, MA 02151-5349
Phone (781) 284-2275

Other names 1

  • broadway dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Smile Dental PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1053618140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 BROADWAY # 2",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515349",
            "telephone_number": "781-284-2275",
            "fax_number": "781-426-7614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 BROADWAY # 2",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515349",
            "telephone_number": "781-284-2275",
            "fax_number": "781-426-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-25",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "OSTROVSKY",
        "authorized_official_first_name": "BELLA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "781-284-2275"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN19044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "broadway dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "broadway dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.