Provider Demographics
NPI:1154798247
Name:SPH3 ENTERPRISE LLC
Entity type:Organization
Organization Name:SPH3 ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-644-0099
Mailing Address - Street 1:194 BUCKLAND HILLS DR
Mailing Address - Street 2:SUITE 1076
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 BUCKLAND HILLS DR
Practice Address - Street 2:SUITE 1076
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8705
Practice Address - Country:US
Practice Address - Phone:860-644-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty