Healthcare Provider Details

I. General information

NPI: 1700791266
Provider Name (Legal Business Name): GORGEOUS SMILES DENTAL MERIDEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S BROAD ST STE 24
MERIDEN CT
06450-6661
US

IV. Provider business mailing address

533 S BROAD ST STE 24
MERIDEN CT
06450-6661
US

V. Phone/Fax

Practice location:
  • Phone: 203-238-7968
  • Fax:
Mailing address:
  • Phone: 203-238-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND JOSEPH BELISLE JR.
Title or Position: COO
Credential: COO
Phone: 860-978-3294