Gorgeous Smiles Dental, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GORGEOUS SMILES DENTAL, PC

Doing business as

First Line Dental

Practice address

238C Tolland Tpke
Manchester, CT 06042-5702

Phone

(860) 259-4039

NPI assigned

Apr 17, 2023

Last updated

Apr 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Raymond Belisle

Title

Coo

Phone

(860) 978-3294

Specialties & licenses 1

Addresses

Other names 1

• First Line Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mohammad Abbas Khan, DMD

  • Dentist
  • South Windsor, CT
  • NPI 1366952897

  General Practice

  NPD

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1255027850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238C TOLLAND TPKE",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060425702",
            "telephone_number": "860-259-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238C TOLLAND TPKE",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060425702",
            "telephone_number": "860-259-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORGEOUS SMILES DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-15",
        "status": "A",
        "authorized_official_last_name": "BELISLE",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "860-978-3294",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Line Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daresa Gordon
• Monique Gordon
• Samantha Gordon
• Shakina M Gordon, MS, LPC
• Zyann J Gordon
• Chelsea Gouldsbrough
• Grace Health PLLC
• Howard Steven Grad, OD
• Ian Graf, DO
• Erin Marie Graffam, LPC

• General Practice Dentistry in Manchester, CT
• Providers in Manchester, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.