Provider Demographics
NPI:1649818840
Name:SIMPLY SMILES, INC.
Entity type:Organization
Organization Name:SIMPLY SMILES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COLTER
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBELLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, CSW -PIP
Authorized Official - Phone:203-810-4041
Mailing Address - Street 1:1771 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5606
Mailing Address - Country:US
Mailing Address - Phone:203-810-4041
Mailing Address - Fax:
Practice Address - Street 1:27249 HWY 212
Practice Address - Street 2:
Practice Address - City:LA PLANT
Practice Address - State:SD
Practice Address - Zip Code:57652
Practice Address - Country:US
Practice Address - Phone:032-810-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care AgencyGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty