Active NPI
Hartford Smiles Youth Dentistry, PC
- General Practice Dentistry
- Hartford, CT
National Provider Identifier
1265620082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- HARTFORD SMILES YOUTH DENTISTRY, PC
- Practice address
- 272 Franklin Ave
Hartford, CT 06114-1848 - Phone
- (860) 296-5437
- Fax
- (860) 296-5454
- NPI assigned
- Oct 5, 2007
- Last updated
- Jul 9, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Jenell Stump
- Title
- Manager, Licensing & Credentialing
- Phone
- (615) 750-0343
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | NU | ||
| General Practice Dentistry | 1223G0001X | NU | Primary | |
| Pediatric Dentistry | 1223P0221X | NU | ||
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | NU | ||
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | NU |
Addresses
Primary practice location
272 Franklin Ave
Hartford, CT 06114-1848
Mailing address
16 Arcade Unit 198747
Nashville, TN 37219-1994
Phone (615) 750-0343
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500000056 | Medicaid | CT |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191542400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1404864000000",
"number": "1265620082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 ARCADE UNIT 198747",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372191994",
"telephone_number": "615-750-0343",
"fax_number": "615-986-1705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 FRANKLIN AVE",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061141848",
"telephone_number": "860-296-5437",
"fax_number": "860-296-5454"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HARTFORD SMILES YOUTH DENTISTRY, PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-10-05",
"last_updated": "2014-07-09",
"status": "A",
"authorized_official_last_name": "STUMP",
"authorized_official_first_name": "JENELL",
"authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
"authorized_official_telephone_number": "615-750-0343",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500000056",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.