| Kristal Smiles | |
|
109 Watertown Ave Ste 1 Waterbury CT 06708-2623 | |
| (203) 754-7100 | |
| Not Available |
| Full Name | Kristal Smiles |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 109 Watertown Ave Ste 1, Waterbury, Connecticut |
| Authorized Official Name and Position | Thomas Braun (MANAGER) |
| Authorized Official Contact | 2037547100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kristal Smiles 427 Stillson Rd Ste 12 Fairfield CT 06824-3158 Ph: (203) 374-0512 | Kristal Smiles 109 Watertown Ave Ste 1 Waterbury CT 06708-2623 Ph: (203) 754-7100 |
| NPI Number | 1912394834 |
|---|---|
| Provider Enumeration Date | 04/17/2015 |
| Last Update Date | 04/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912394834 | NPI | - | NPPES |
| P002058253 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 005825 (Connecticut) | Primary |
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