Provider Demographics
NPI:1326646399
Name:RESTORATION SMILES, P.C.
Entity Type:Organization
Organization Name:RESTORATION SMILES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-863-9987
Mailing Address - Street 1:22 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1056
Mailing Address - Country:US
Mailing Address - Phone:845-863-9987
Mailing Address - Fax:
Practice Address - Street 1:2 COOLIDGE ST STE 202
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1459
Practice Address - Country:US
Practice Address - Phone:845-863-9987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental