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General NPI Number Information
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NPI Number | 1700791266
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Entity Type | Organization
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Legal Business Name | GORGEOUS SMILES DENTAL MERIDEN PLLC
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 533 S BROAD ST STE 24
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City | MERIDEN
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State | CT
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Zip | 06450-6661
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Country | US
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Telephone | 203-238-7968
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Fax |
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Provider Business Mailing Address
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Address Line | 533 S BROAD ST STE 24
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City | MERIDEN
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State | CT
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Zip | 06450-6661
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Country | US
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Telephone | 203-238-7968
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. RAYMOND JOSEPH BELISLE JR.
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Credential | COO
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Telephone | 860-978-3294
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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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