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General NPI Number Information
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NPI Number | 1033669866
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Entity Type | Organization
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Legal Business Name | THE SMILE SPOT
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 250 MAIN ST S
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City | SOUTHBURY
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State | CT
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Zip | 06488-2263
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Country | US
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Telephone | 203-405-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 250 MAIN ST S
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City | SOUTHBURY
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State | CT
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Zip | 06488-2263
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Country | US
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Telephone | 203-405-6301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN ERIC KEST
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Credential |
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Telephone | 203-405-6301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 009872
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License Number State | CT
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