| Worcester Smiles Youth Dentistry, Llc | |
|
290 Park Ave Worcester MA 01609-1805 | |
| (508) 798-9040 | |
| (508) 798-9060 |
| Full Name | Worcester Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 290 Park Ave, Worcester, Massachusetts |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Worcester Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Worcester Smiles Youth Dentistry, Llc 290 Park Ave Worcester MA 01609-1805 Ph: (508) 798-9040 |
| NPI Number | 1073661385 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073661385 | NPI | - | NPPES |
| 110069690A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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