Provider Demographics
NPI:1447508627
Name:CARVER SMILES P.C.
Entity type:Organization
Organization Name:CARVER SMILES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BLEAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-557-1116
Mailing Address - Street 1:300 TREMONT ST STE 6
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1761
Mailing Address - Country:US
Mailing Address - Phone:508-866-5550
Mailing Address - Fax:
Practice Address - Street 1:300 TREMONT ST STE 6
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1761
Practice Address - Country:US
Practice Address - Phone:508-866-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18553761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty