Provider Demographics
NPI:1447575055
Name:DYNOBITE SMILES
Entity Type:Organization
Organization Name:DYNOBITE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-577-3500
Mailing Address - Street 1:765 STRAITS TPKE
Mailing Address - Street 2:DYNOBITE SMILES
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2853
Mailing Address - Country:US
Mailing Address - Phone:203-577-3500
Mailing Address - Fax:203-577-3600
Practice Address - Street 1:765 STRAITS TPKE
Practice Address - Street 2:DYNOBITE SMILES
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2853
Practice Address - Country:US
Practice Address - Phone:203-577-3500
Practice Address - Fax:203-577-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty