Provider Demographics
NPI:1346600368
Name:THALODY FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:THALODY FAMILY DENTISTRY LLC
Other - Org Name:PORTLAND SMILE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:THALODY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-342-2176
Mailing Address - Street 1:260 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1859
Mailing Address - Country:US
Mailing Address - Phone:860-342-2176
Mailing Address - Fax:860-342-2177
Practice Address - Street 1:260 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480
Practice Address - Country:US
Practice Address - Phone:860-342-2176
Practice Address - Fax:860-342-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008931122300000X
CT004615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty