Healthcare Provider Details

I. General information

NPI: 1316184633
Provider Name (Legal Business Name): SMILE MAKERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 STRAWBERRY HILL AVE 6
STAMFORD CT
06902
US

IV. Provider business mailing address

165 HUNTINGTON RD
STRATFORD CT
06614-4008
US

V. Phone/Fax

Practice location:
  • Phone: 203-386-9855
  • Fax:
Mailing address:
  • Phone: 203-386-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9068
License Number StateCT

VIII. Authorized Official

Name: DR. JACEK ZIEMSKI
Title or Position: PRESIDENT
Credential: DDS
Phone: 203-516-2006