Healthcare Provider Details

I. General information

NPI: 1891582862
Provider Name (Legal Business Name): SMILES IN BLOOM BLOOMFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 JEROME AVE STE 200
BLOOMFIELD CT
06002-2463
US

IV. Provider business mailing address

137 PROSPECT HILL RD
EAST WINDSOR CT
06088-3602
US

V. Phone/Fax

Practice location:
  • Phone: 860-254-5840
  • Fax:
Mailing address:
  • Phone: 860-254-5840
  • Fax: 860-254-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID B WEISHUHN
Title or Position: OWNER
Credential: DDS, MS
Phone: 860-254-5840