Healthcare Provider Details

I. General information

NPI: 1942658869
Provider Name (Legal Business Name): TSM1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 OXFORD RD
OXFORD CT
06478-1644
US

IV. Provider business mailing address

318 OXFORD RD
OXFORD CT
06478-1644
US

V. Phone/Fax

Practice location:
  • Phone: 203-888-0811
  • Fax: 203-888-1870
Mailing address:
  • Phone: 203-888-0811
  • Fax: 203-888-1870

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: DR. STEPHEN KEST
Title or Position: OWNER
Credential: DMD
Phone: 412-400-3510