| Brockton Smiles Youth Dentistry, Llc | |
|
70 Westgate Dr Brockton MA 02301-1811 | |
| (508) 588-8090 | |
| (508) 588-8010 |
| Full Name | Brockton Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 70 Westgate Dr, Brockton, 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 |
|---|---|
| Brockton Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Brockton Smiles Youth Dentistry, Llc 70 Westgate Dr Brockton MA 02301-1811 Ph: (508) 588-8090 |
| NPI Number | 1851581243 |
|---|---|
| Provider Enumeration Date | 07/31/2007 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851581243 | NPI | - | NPPES |
| 110077842A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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