Healthcare Provider Details

I. General information

NPI: 1942911524
Provider Name (Legal Business Name): STRATFORD SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MAIN ST
STRATFORD CT
06614-4978
US

IV. Provider business mailing address

2945 MAIN ST
STRATFORD CT
06614-4978
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-3068
  • 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: DR. YUCHEN SHENG
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 215-703-8680