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General NPI Number Information
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NPI Number | 1548502750
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Entity Type | Organization
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Legal Business Name | SMILE BY DESIGN WINDSOR LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 697 POQUONOCK AVENUE
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City | WINDSOR
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State | CT
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Zip | 06010-2259
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Country | US
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Telephone | 860-219-0932
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Fax | 860-219-1482
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Provider Business Mailing Address
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Address Line | P.O BOX 566
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City | WINDSOR
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State | CT
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Zip | 06010-2259
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Country | US
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Telephone | 860-219-0932
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Fax | 860-219-1482
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | SALEH AKBAR
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Credential |
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Telephone | 860-219-0932
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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 |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 006903
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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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 |
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11249
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | P07893
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License Number State | CT
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