Provider Demographics
NPI:1326720194
Name:ISMILE ORTHODONTICS OF WATERBURY LLC
Entity Type:Organization
Organization Name:ISMILE ORTHODONTICS OF WATERBURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EFSTATHIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNOUTSOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-518-9128
Mailing Address - Street 1:464 REIDVILLE DRIVE, SUITE A4
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2650
Mailing Address - Country:US
Mailing Address - Phone:203-601-6423
Mailing Address - Fax:203-575-8399
Practice Address - Street 1:464 REIDVILLE DRIVE, SUITE A4
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2650
Practice Address - Country:US
Practice Address - Phone:203-601-6423
Practice Address - Fax:203-575-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty