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General NPI Number Information
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NPI Number | 1477919058
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Entity Type | Organization
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Legal Business Name | SMILE BY DESIGN HARTFORD LLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 377 FRANKLIN AVE
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City | HARTFORD
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State | CT
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Zip | 06114-2563
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Country | US
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Telephone | 860-296-9910
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Fax | 860-219-1482
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Provider Business Mailing Address
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Address Line | 377 FRANKLIN AVE
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City | HARTFORD
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State | CT
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Zip | 06114-2563
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Country | US
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Telephone | 860-296-9910
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Fax | 860-219-1482
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Authorized Official
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Title or Position | PRESIDENT
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Name | SALEH AL KHARSA
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Credential | DMD
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Telephone | 860-219-0933
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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 | 7893
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7893
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7893
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7893
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License Number State | CT
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