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General NPI Number Information
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NPI Number | 1942658869
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Entity Type | Organization
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Legal Business Name | TSM1 LLC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 318 OXFORD RD
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City | OXFORD
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State | CT
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Zip | 06478-1644
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Country | US
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Telephone | 203-888-0811
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Fax | 203-888-1870
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Provider Business Mailing Address
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Address Line | 318 OXFORD RD
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City | OXFORD
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State | CT
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Zip | 06478-1644
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Country | US
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Telephone | 203-888-0811
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Fax | 203-888-1870
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN KEST
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Credential | DMD
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Telephone | 412-400-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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