Sph3Enterprise, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

010954 Issued in CT

Legal business name

SPH3ENTERPRISE, LLC

Practice address

194 Buckland Hills Drive
Manchester, CT 06042

Phone

(860) 644-0099

Fax

(860) 644-0109

NPI assigned

Jul 7, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andre Lavoie

Title

Office Manager

Phone

(860) 644-0099

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Buckland Hills Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• SPH3 Enterprise LLC

  • Pediatric Dentistry
  • Manchester, CT
  • NPI 1154798247
  NPD tax ID
• SPH3 Enterprise, LLC

  dba Buckland Hills Dental

  • General Practice Dentistry
  • Manchester, CT
  • NPI 1972893352
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1053727479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 BUCKLAND HILLS DR",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060428705",
            "telephone_number": "860-644-0099",
            "fax_number": "860-644-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 BUCKLAND HILLS DRIVE",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06042",
            "telephone_number": "860-644-0099",
            "fax_number": "860-644-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPH3ENTERPRISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "LAVOIE",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-644-0099"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "010954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467611632",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972893352",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Spector, DDS
• Spectrum Healthcare Manchester, LLC (Crestfield Rehabilitation Center & Fenwood Manor)
• Arriyana Je Spence
• SPH3 Enterprise LLC
• SPH3 Enterprise, LLC (Buckland Hills Dental)
• Kenneth N. Spiegelman, M.D.
• Splinting Solutions, LLC
• Rachel Sponzo
• Sports Medicine and Orthopedic Surgery, P.C.
• Monica Srodon, M.D.

• Pediatric Dentistry in Manchester, CT
• Providers in Manchester, CT by specialty
• Pediatric Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.