Provider Demographics
NPI:1205303856
Name:SOUTHPORT SMILES DENTISTRY, P.C.
Entity type:Organization
Organization Name:SOUTHPORT SMILES DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVYN
Authorized Official - Middle Name:SIN-CHUN
Authorized Official - Last Name:YEOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-319-1300
Mailing Address - Street 1:8 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1437
Mailing Address - Country:US
Mailing Address - Phone:203-319-1300
Mailing Address - Fax:203-319-0893
Practice Address - Street 1:8 JOHN ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1437
Practice Address - Country:US
Practice Address - Phone:203-319-1300
Practice Address - Fax:203-319-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty