Healthcare Provider Details

I. General information

NPI: 1316456742
Provider Name (Legal Business Name): SMILE RITE DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 QUEEN ST UNIT 2
SOUTHINGTON CT
06489-1505
US

IV. Provider business mailing address

685 QUEEN ST UNIT 3
SOUTHINGTON CT
06489-1547
US

V. Phone/Fax

Practice location:
  • Phone: 860-863-5831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NISHIT R MODI
Title or Position: OWNER
Credential: DMD
Phone: 860-329-6539