Organization
SMILE DESIGN BOSTON
Active
Other names
Smile Design Boston
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE HASHEM DMD (OWNER)
(617) 840-0627
Entity
Organization
Contact information
Practice address
21 CUSTOM HOUSE ST STE 110, BOSTON, MA 02110-3525
(617) 840-0627
Mailing address
15 WAVERLY ST APT 260, BRIGHTON, MA 02135-1245
(617) 840-0627
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN1856740
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487727301
DELTA DENTAL PREMIER
—
Enumeration date
05/06/2018
Last updated
05/06/2018
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