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General NPI Number Information
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NPI Number | 1154814069
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Entity Type | Organization
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Legal Business Name | SIGNATURE SMILES OF HARTFORD LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 550 FARMINGTON AVENUE, SUITE B
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City | HARTFORD
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State | CT
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Zip | 06105
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Country | US
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Telephone | 860-956-5555
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Fax | 860-956-5311
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Provider Business Mailing Address
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Address Line | 550 FARMINGTON AVENUE SUITE B
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City | HARTFORD
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State | CT
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Zip | 06105
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Country | US
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Telephone | 860-956-5555
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Fax | 860-956-5311
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Authorized Official
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Title or Position | MANAGER
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Name | SALEH AKBAR
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Credential |
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Telephone | 860-680-6326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11401
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License Number State | CT
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