Provider Demographics
NPI:1124092093
Name:SMITH WILLIAMS, JENNIFER E (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:SMITH WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:575 BOYLSTON ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-267-7002
Practice Address - Fax:617-536-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA164181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16537OtherHARVARD PILGRIM HEALTHCAR
MA0273015Medicaid
MAX06271SMOtherBCBS
MA0273015Medicaid
T93242Medicare UPIN