Organization
WORCESTER SMILES YOUTH DENTISTRY, LLC
Active
Parent organization
WORCESTER SMILES YOUTH DENTISTRY, LLC
Other names
Straight Smiles of Worcester
Organization subpart
Yes
Provider details
NPI number
Legal business name
WORCESTER SMILES YOUTH DENTISTRY, LLC
Authorized official
MRS. JENELL STUMP (MANAGER, L & C)
(615) 750-0343
Entity
Organization
Contact information
Practice address
388 PARK AVE, WORCESTER, MA 01610-1025
(508) 798-6565
(508) 798-6687
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110088462A
—
MA
Enumeration date
03/28/2011
Last updated
07/09/2014
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