Provider Demographics
NPI:1871251058
Name:SMILE ARK PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:SMILE ARK PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-372-2532
Mailing Address - Street 1:354 WHEELERS FARMS RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1803
Mailing Address - Country:US
Mailing Address - Phone:617-372-2532
Mailing Address - Fax:
Practice Address - Street 1:2480 BLACK ROCK TPKE # S1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-2418
Practice Address - Country:US
Practice Address - Phone:203-763-4200
Practice Address - Fax:203-763-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty