Provider Demographics
NPI:1215596325
Name:LASTING SMILES OF STRATFORD, LLC
Entity Type:Organization
Organization Name:LASTING SMILES OF STRATFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DHARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-378-2760
Mailing Address - Street 1:1100 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4901
Mailing Address - Country:US
Mailing Address - Phone:203-873-0650
Mailing Address - Fax:203-845-1829
Practice Address - Street 1:1100 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4901
Practice Address - Country:US
Practice Address - Phone:203-873-0650
Practice Address - Fax:203-845-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty