Provider Demographics
NPI:1063050078
Name:SIMPLY SMILES, INC.
Entity type:Organization
Organization Name:SIMPLY SMILES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COLTER
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBELLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CSW - PIP
Authorized Official - Phone:203-810-4041
Mailing Address - Street 1:1771 POST ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-810-4041
Mailing Address - Fax:
Practice Address - Street 1:27249 HWY 212
Practice Address - Street 2:
Practice Address - City:LA PLANT
Practice Address - State:SD
Practice Address - Zip Code:57652
Practice Address - Country:US
Practice Address - Phone:774-328-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLY SMILES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty