Provider Demographics
NPI:1104312271
Name:SMILE CENTER FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:SMILE CENTER FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEENISH
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-584-8444
Mailing Address - Street 1:47 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-5102
Mailing Address - Country:US
Mailing Address - Phone:860-584-8444
Mailing Address - Fax:
Practice Address - Street 1:47 MAIN ST
Practice Address - Street 2:
Practice Address - City:TERRYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06786-5102
Practice Address - Country:US
Practice Address - Phone:860-584-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010960261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental