The Smile Studio at Bushnell Park

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THE SMILE STUDIO AT BUSHNELL PARK

Doing business as

The Smile Studio at Bushnell Park

Practice address

1 Gold St Ste Q
Hartford, CT 06103-2914

Phone

(860) 728-5264

NPI assigned

Dec 23, 2019

Last updated

Dec 23, 2019By 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

Bryan Wilson, DDS

Title

Owner

Phone

(860) 728-5264

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Smile Studio at Bushnell Park Doing business as

Electronic endpoints 1

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.

• Arfassa Gullo

  • Dentist
  • West Hartford, CT
  • NPI 1639672231
  NPD

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

{
    "created_epoch": "1577059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577059200000",
    "number": "1295374296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GOLD ST STE Q",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061032914",
            "telephone_number": "860-728-5264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOLD ST STE Q",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061032914",
            "telephone_number": "860-728-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SMILE STUDIO AT BUSHNELL PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-728-5264",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1093881534",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Email",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Gold St Ste Q",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061032914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Smile Studio at Bushnell Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Latin Enrichment Organization LLC
• The Latin Enrichment Organization LLC
• The Latin Enrichment Organization LLC (L.E.O. Clinic)
• The Life Center of CT, Inc.
• The Rowan Center for Wellness LLC
• The Village for Families & Children, Inc.
• The Village for Families & Children, Inc.
• The Village for Families and Children
• The Villages
• Farah Themistocle, DMD

• General Practice Dentistry in Hartford, CT
• Providers in Hartford, 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 Dec 23, 2019; 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.