Provider Demographics
NPI:1174929970
Name:MANCHESTER SMILES FAMILY AND IMPLANT DENTISTRY LLC
Entity type:Organization
Organization Name:MANCHESTER SMILES FAMILY AND IMPLANT DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:VIPIN
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-861-3531
Mailing Address - Street 1:168 SPENCER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-649-2796
Mailing Address - Fax:
Practice Address - Street 1:168 SPENCER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4616
Practice Address - Country:US
Practice Address - Phone:860-649-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty