Organization
BROAD SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HUBERT J PARK DMD, MPH (PRESIDENT)
(617) 895-6700
Entity
Organization
Contact information
Practice address
600 LORING AVE STE 8, SALEM, MA 01970-4264
(978) 910-0004
Mailing address
600 LORING AVE STE 8, SALEM, MA 01970-4264
(978) 910-0004
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
06/05/2021
Last updated
06/05/2021
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