Provider Demographics
NPI:1639722671
Name:LASTING SMILES OF PROSPECT
Entity Type:Organization
Organization Name:LASTING SMILES OF PROSPECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:SOCARRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-527-3855
Mailing Address - Street 1:60 WATERBURY RD STE E
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1251
Mailing Address - Country:US
Mailing Address - Phone:203-527-3855
Mailing Address - Fax:203-528-4385
Practice Address - Street 1:60 WATERBURY RD STE E
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1251
Practice Address - Country:US
Practice Address - Phone:203-527-3855
Practice Address - Fax:203-528-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental