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General NPI Number Information
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NPI Number | 1902602394
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Entity Type | Organization
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Legal Business Name | ELITE SMILES ARTISTRY, PLLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 267 SPIELMAN HWY
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City | BURLINGTON
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State | CT
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Zip | 06013-1741
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Country | US
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Telephone | 860-470-5877
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Fax |
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Provider Business Mailing Address
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Address Line | 283 CHESTNUT HILL RD
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City | LITCHFIELD
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State | CT
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Zip | 06759-4104
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Country | US
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Telephone | 860-790-0260
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ANATOLIY RAVIN
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Credential | DDS MBA
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Telephone | 860-790-0260
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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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