Provider Demographics
NPI:1902324650
Name:HS SMILES,LLC
Entity Type:Organization
Organization Name:HS SMILES,LLC
Other - Org Name:PRIMEDENTALCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THULASISWARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUPPURU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-664-1994
Mailing Address - Street 1:2 LONG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1111
Mailing Address - Country:US
Mailing Address - Phone:203-664-1994
Mailing Address - Fax:
Practice Address - Street 1:2 LONG RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-1111
Practice Address - Country:US
Practice Address - Phone:203-664-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103181223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty