Worcester Smiles Youth Dentistry, LLC
Dentist, General Practice in Worcester, MA. Organization (NPI-2).
Details
- NPI
- 1073661385
- Entity type
- Organization (NPI-2)
- Legal business name
- Worcester Smiles Youth Dentistry, LLC
- Organization subpart
- No
- Enumeration date
- Jan 5, 2007
- Last updated
- Jul 9, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
290 Park AveWorcester, MA 01609-1805
Phone 508-798-9040 · Fax 508-798-9060
Mailing address
16 Arcade Unit 198747Nashville, TN 37219-1994
Phone 615-750-0343 · Fax 615-986-1705
Authorized official
Jenell Stump
Manager, Licensing & Credentialing
6157500343
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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