Mattapan Smiles Youth Dentistry, LLC
NPI #1619065901 in Mattapan, Massachusetts
Provider Information
- NPI Number
- 1619065901
- Entity Type
- Organization
- Organization Name
- Mattapan Smiles Youth Dentistry, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Oct 11, 2006
- Last Updated
- Jul 9, 2014
Practice Location
- Address
- 90 RIVER ST
- City
- Mattapan
- State
- Massachusetts
- ZIP Code
- 02126-2914
- Phone
- (617) 698-5437
Authorized Official
- Name
- MRS. JENELL STUMP
- Title
- MANAGER, LICENSING & CREDENTIALING
- Phone
- (615) 750-0343
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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