=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548484561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILES FOR THE FUTURE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 01/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 379 NAUBUC AVE
-----------------------------------------------------
City | GLASTONBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06033-1076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-633-5246
-----------------------------------------------------
Fax | 860-633-5249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 379 NAUBUC AVE
-----------------------------------------------------
City | GLASTONBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06033-1076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-633-5246
-----------------------------------------------------
Fax | 860-633-5249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | MRS. MAGDALENA Z TAUBER
-----------------------------------------------------
Credential | D.M.D,
-----------------------------------------------------
Telephone | 860-633-5246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------