Provider Demographics
NPI:1447881339
Name:SMILE BOUTIQUE, PC
Entity type:Organization
Organization Name:SMILE BOUTIQUE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-729-1444
Mailing Address - Street 1:49 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2508
Mailing Address - Country:US
Mailing Address - Phone:781-729-1444
Mailing Address - Fax:781-729-1233
Practice Address - Street 1:49 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2508
Practice Address - Country:US
Practice Address - Phone:781-729-1444
Practice Address - Fax:781-729-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty