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General NPI Number Information
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NPI Number | 1215596325
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Entity Type | Organization
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Legal Business Name | LASTING SMILES OF STRATFORD, LLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1100 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614-4901
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Country | US
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Telephone | 203-873-0650
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Fax | 203-845-1829
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Provider Business Mailing Address
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Address Line | 1100 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614-4901
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Country | US
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Telephone | 203-873-0650
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Fax | 203-845-1829
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Authorized Official
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Title or Position | OWNER
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Name | DR. DHARAM TAYAL
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Credential | DDS
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Telephone | 203-378-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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