Provider Demographics
NPI:1346074143
Name:PERFECT SMILE DENTAL PC
Entity type:Organization
Organization Name:PERFECT SMILE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NISHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-329-6539
Mailing Address - Street 1:685 QUEEN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1547
Mailing Address - Country:US
Mailing Address - Phone:860-863-5831
Mailing Address - Fax:860-863-5832
Practice Address - Street 1:1131 TOLLAND TPKE STE J
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1679
Practice Address - Country:US
Practice Address - Phone:860-533-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFECT SMILE DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty