Provider Demographics
NPI:1679013361
Name:AUTHENTIC SMILES LLC
Entity Type:Organization
Organization Name:AUTHENTIC SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-301-7666
Mailing Address - Street 1:59 TURNPIKE SQ
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2758
Mailing Address - Country:US
Mailing Address - Phone:203-876-6161
Mailing Address - Fax:
Practice Address - Street 1:59 TURNPIKE SQ
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2758
Practice Address - Country:US
Practice Address - Phone:203-876-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty