Pristine Smile Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRISTINE SMILE DENTAL PLLC

Practice address

599 Main St Ste 4
Manchester, CT 06040-5156

Phone

(860) 647-1565

Fax

(860) 643-2796

NPI assigned

Feb 20, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Jason Lee Hernandez, DMDNPI 1851688584

Title

Dentist Owner

Phone

(860) 990-1792

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Hernandez, DMD

  • General Practice Dentistry
  • Willimantic, CT
  • NPI 1851688584
  NPD Authorized official

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

{
    "created_epoch": "1645315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645315200000",
    "number": "1316692106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 MAIN ST STE 4",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060405156",
            "telephone_number": "860-647-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 MAIN ST STE 4",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060405156",
            "telephone_number": "860-647-1565",
            "fax_number": "860-643-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE SMILE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-20",
        "last_updated": "2022-02-20",
        "certification_date": "2022-02-20",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "860-990-1792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucia Pratto
• Lisa Preble, LADC, LCSW
• Ida K Price
• Kylie Angelina Price
• Susan N. Price, LCSW
• Stephanie Gabrielle Proano, APRN
• Professional Family Therapy-LLC
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• Prohealth Chiropractic Center, LLC
• Prospect CT Medical Foundation, Inc.

• 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 Feb 20, 2022; 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.