Provider Demographics
NPI:1366289191
Name:CONCORD SMILES LLC
Entity type:Organization
Organization Name:CONCORD SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:PAPAPETROS
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-886-2678
Mailing Address - Street 1:13 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3742
Mailing Address - Country:US
Mailing Address - Phone:603-225-2042
Mailing Address - Fax:
Practice Address - Street 1:13 WALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3742
Practice Address - Country:US
Practice Address - Phone:603-225-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental