Provider Demographics
NPI:1053894261
Name:DENTAL SMILES OF ORANGE LLC
Entity type:Organization
Organization Name:DENTAL SMILES OF ORANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-553-9500
Mailing Address - Street 1:109 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3235
Mailing Address - Country:US
Mailing Address - Phone:203-553-9500
Mailing Address - Fax:
Practice Address - Street 1:109 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3235
Practice Address - Country:US
Practice Address - Phone:203-553-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1376733139Medicaid