1548502750 NPI number — SMILE BY DESIGN WINDSOR LLC

Table of content: (NPI 1548502750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548502750 NPI number — SMILE BY DESIGN WINDSOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILE BY DESIGN WINDSOR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDS DENTAL CARE WINDSOR LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548502750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06010-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-219-0932
Provider Business Mailing Address Fax Number:
860-219-1482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
697 POQUONOCK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06010-2259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-219-0932
Provider Business Practice Location Address Fax Number:
860-219-1482
Provider Enumeration Date:
03/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
AKBAR
Authorized Official First Name:
SALEH
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
860-219-0932

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223D0004X , with the licence number: 006903 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223D0004X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: P07893 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 11249 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com