Provider Demographics
NPI:1689064669
Name:SMILEORA LLC
Entity Type:Organization
Organization Name:SMILEORA LLC
Other - Org Name:SMILEORA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-265-7890
Mailing Address - Street 1:430 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2481
Mailing Address - Country:US
Mailing Address - Phone:860-265-7890
Mailing Address - Fax:206-984-3168
Practice Address - Street 1:430 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2481
Practice Address - Country:US
Practice Address - Phone:860-265-7890
Practice Address - Fax:206-984-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty