Provider Demographics
NPI:1356693642
Name:SMILE MASTER OF CONCORD
Entity type:Organization
Organization Name:SMILE MASTER OF CONCORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:H
Authorized Official - Last Name:EL-SHERIF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MSCD,PHD
Authorized Official - Phone:603-856-8767
Mailing Address - Street 1:246 PLEASANT ST # 225A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-856-8767
Mailing Address - Fax:603-856-8026
Practice Address - Street 1:246 PLEASANT ST # 225A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-856-8767
Practice Address - Fax:603-856-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2650261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental