Provider Demographics
NPI:1467886614
Name:ISMILE ORTHODONTICSOF LLC
Entity Type:Organization
Organization Name:ISMILE ORTHODONTICSOF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-282-4500
Mailing Address - Street 1:2417 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1802
Mailing Address - Country:US
Mailing Address - Phone:475-282-4500
Mailing Address - Fax:
Practice Address - Street 1:2417 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-1802
Practice Address - Country:US
Practice Address - Phone:475-282-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0536891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty