Healthcare Provider Details

I. General information

NPI: 1548484561
Provider Name (Legal Business Name): SMILES FOR THE FUTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 NAUBUC AVE
GLASTONBURY CT
06033-1076
US

IV. Provider business mailing address

379 NAUBUC AVE
GLASTONBURY CT
06033-1076
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-5246
  • Fax: 860-633-5249
Mailing address:
  • Phone: 860-633-5246
  • Fax: 860-633-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAGDALENA Z TAUBER
Title or Position: OWNER/DENTIST
Credential: D.M.D,
Phone: 860-633-5246