Worcester Smiles Youth Dentistry, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

WORCESTER SMILES YOUTH DENTISTRY, LLC

Practice address

388 Park Ave
Worcester, MA 01610-1025

Phone

(508) 798-6565

Fax

(508) 798-6687

NPI assigned

Mar 28, 2011

Organization subpart

Yes

Parent organization

WORCESTER SMILES YOUTH DENTISTRY, LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Jenell Stump

Title

Manager, L & C

Phone

(615) 750-0343

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Straight Smiles of Worcester Doing business as

Tax ID family

Worcester Smiles Youth Dentistry LLC2 organizations share this tax ID, including this one

Part of

Worcester Smiles Youth Dentistry LLC

Other organizations with this tax ID 1

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

• Worcester Smiles Youth Dentistry, LLC

  • General Practice Dentistry
  • Worcester, MA
  • NPI 1073661385
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Worcester Smiles Youth Dentistry, LLC

  • General Practice Dentistry
  • Worcester, MA
  • NPI 1073661385
  NPPES parent name

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1487943635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 PARK AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016101025",
            "telephone_number": "508-798-6565",
            "fax_number": "508-798-6687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WORCESTER SMILES YOUTH DENTISTRY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WORCESTER SMILES YOUTH DENTISTRY, LLC",
        "enumeration_date": "2011-03-28",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER, L & C",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110088462A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Straight Smiles of Worcester",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Worcester Smiles Youth Dentistry, LLC
• Worcester Urological Associates Inc
• Jonathan Alan Worcester, PH.D., NCSP, BCBA-D
• Sylvia Worrell, DO
• Cynthia A Worthington
• Angela S Wozniak

• All providers in Worcester, MA
• Orthodontics and Dentofacial Orthopedics Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.