Provider Demographics
NPI:1548502750
Name:SMILE BY DESIGN WINDSOR LLC
Entity type:Organization
Organization Name:SMILE BY DESIGN WINDSOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AKBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-219-0932
Mailing Address - Street 1:P.O BOX 566
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06010-2259
Mailing Address - Country:US
Mailing Address - Phone:860-219-0932
Mailing Address - Fax:860-219-1482
Practice Address - Street 1:697 POQUONOCK AVENUE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06010-2259
Practice Address - Country:US
Practice Address - Phone:860-219-0932
Practice Address - Fax:860-219-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122300000X, 1223D0004X, 1223G0001X
CT0069031223D0004X
CT112491223X0400X
CTP078931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty