Provider Demographics
NPI:1518389618
Name:SMILES OF HARTFORD LLC
Entity Type:Organization
Organization Name:SMILES OF HARTFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTA MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-997-0569
Mailing Address - Street 1:48 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-3414
Mailing Address - Country:US
Mailing Address - Phone:860-444-9345
Mailing Address - Fax:860-443-0432
Practice Address - Street 1:48 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-3414
Practice Address - Country:US
Practice Address - Phone:860-444-9345
Practice Address - Fax:860-443-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1073873OtherBUSINESS ID SECRETARY OF THE STATE OF CONNECTICUT