Provider Demographics
NPI:1477919058
Name:SMILE BY DESIGN HARTFORD LLC
Entity Type:Organization
Organization Name:SMILE BY DESIGN HARTFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:AL
Authorized Official - Last Name:KHARSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-219-0933
Mailing Address - Street 1:377 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2563
Mailing Address - Country:US
Mailing Address - Phone:860-296-9910
Mailing Address - Fax:860-219-1482
Practice Address - Street 1:377 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2563
Practice Address - Country:US
Practice Address - Phone:860-296-9910
Practice Address - Fax:860-219-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7893122300000X, 1223G0001X, 1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty