Healthcare Provider Details

I. General information

NPI: 1174225759
Provider Name (Legal Business Name): SW SMILES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 BUCKLAND RD STE 202
SOUTH WINDSOR CT
06074-3737
US

IV. Provider business mailing address

29 LISE CIR
SUFFIELD CT
06078-1381
US

V. Phone/Fax

Practice location:
  • Phone: 860-648-9335
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. PRABHJOT SINGH
Title or Position: OWNER
Credential: DDS
Phone: 929-484-7828