Broad Smiles LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

BROAD SMILES LLC

Practice address

600 Loring Ave Ste 8
Salem, MA 01970-4264

Phone

(978) 910-0004

NPI assigned

Jun 5, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Hubert J Park, DMD, MPHNPI 1790077857

Title

President

Phone

(617) 895-6700

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hubert J Park, DMD, MPH

  • Pediatric Dentistry
  • Cambridge, MA
  • NPI 1790077857
  NPD Authorized official
• Kyle Matthew Edmonds, DDS

  • Pediatric Dentistry
  • Salem, MA
  • NPI 1811567498
  NPD

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

{
    "created_epoch": "1622851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622851200000",
    "number": "1831766211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 LORING AVE STE 8",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019704264",
            "telephone_number": "978-910-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 LORING AVE STE 8",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019704264",
            "telephone_number": "978-910-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-05",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "HUBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-895-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MPH"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Brey
• Kelly Catherine Briggs, M.A.
• Bright Care Solutions LLC
• Briliant Dental of Salem
• Carolyn Dilara Bristow
• Gregg Brodsky, MD
• Sydney P Broman, BA
• Brookhouse Home for Aged Women
• Ashley M Brooks, LICSW
• Nancy S Brophy, LICSW

• Pediatric Dentistry in Salem, MA
• Providers in Salem, MA by specialty
• Pediatric Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2021; 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.