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General NPI Number Information
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NPI Number | 1548666142
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Entity Type | Organization
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Legal Business Name | AWESOME SMILES
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Dates
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Enumeration Date | 11/08/2014
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 1163 E MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06608-1620
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Country | US
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Telephone | 203-540-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 BARNUM AVE BARNUM DENTAL
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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 |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VJ SINGH
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Credential |
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Telephone | 203-456-4789
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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 | 10815
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License Number State | CT
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