Provider Demographics
NPI:1952950735
Name:LASTING SMILES OF SAYBROOK, LLC
Entity Type:Organization
Organization Name:LASTING SMILES OF SAYBROOK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOCARRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-400-2566
Mailing Address - Street 1:670 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1520
Mailing Address - Country:US
Mailing Address - Phone:860-661-5163
Mailing Address - Fax:860-388-9023
Practice Address - Street 1:670 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1520
Practice Address - Country:US
Practice Address - Phone:860-661-5163
Practice Address - Fax:860-388-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1902931330Medicaid