Provider Demographics
NPI:1760530315
Name:SMILE CONNECTICUT, PLLC
Entity Type:Organization
Organization Name:SMILE CONNECTICUT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-833-8441
Mailing Address - Street 1:PO BOX 250310
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 RESEARCH DR
Practice Address - Street 2:SUITE 402
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6212
Practice Address - Country:US
Practice Address - Phone:888-833-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty