Provider Demographics
NPI:1568297067
Name:MJ SMILES PC
Entity type:Organization
Organization Name:MJ SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MINWOO
Authorized Official - Middle Name:
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-301-6429
Mailing Address - Street 1:90 QUINCY SHORE DR APT 712
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2922
Mailing Address - Country:US
Mailing Address - Phone:614-301-6429
Mailing Address - Fax:
Practice Address - Street 1:655 BOSTON RD STE 3A
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5338
Practice Address - Country:US
Practice Address - Phone:508-213-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty