Provider Demographics
NPI:1588955538
Name:PERFECT SMILES OF FAIRFIELD
Entity type:Organization
Organization Name:PERFECT SMILES OF FAIRFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-561-5749
Mailing Address - Street 1:60 KATONA DRIVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-561-5749
Mailing Address - Fax:
Practice Address - Street 1:60 KATONA DR
Practice Address - Street 2:SUITE 20
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3544
Practice Address - Country:US
Practice Address - Phone:203-561-5749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty