Healthcare Provider Details

I. General information

NPI: 1154233625
Provider Name (Legal Business Name): MONAMI SMILES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 MAIN ST STE 1
WATERTOWN CT
06795-3131
US

IV. Provider business mailing address

47 MOUNTAIN VIEW RD
GLASTONBURY CT
06033-3525
US

V. Phone/Fax

Practice location:
  • Phone: 860-274-9211
  • Fax: 860-274-3183
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: JAEWOO LEE
Title or Position: OWNER
Credential: DMD
Phone: 617-909-8945