Provider Demographics
NPI:1881074813
Name:CENTRAL SQUARE SMILES
Entity type:Organization
Organization Name:CENTRAL SQUARE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-574-0508
Mailing Address - Street 1:38 CENTRAL SQ
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1911
Mailing Address - Country:US
Mailing Address - Phone:617-569-3131
Mailing Address - Fax:617-567-5361
Practice Address - Street 1:38 CENTRAL SQ
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1911
Practice Address - Country:US
Practice Address - Phone:617-569-3131
Practice Address - Fax:617-567-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18564221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty