Ismile Orthodontics of Waterbury LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

ISMILE ORTHODONTICS OF WATERBURY LLC

Practice address

464 Reidville Drive, Suite A4
Waterbury, CT 06705-2650

Phone

(203) 601-6423

Fax

(203) 575-8399

NPI assigned

Aug 2, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Efstathios Giannoutsos, DDSNPI 1790970374

Title

Owner

Phone

(917) 518-9128

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.

• Efstathios Giannoutsos, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Astoria, NY
  • NPI 1790970374
  NPD Authorized official

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

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690934400000",
    "number": "1326720194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 REIDVILLE DRIVE, SUITE A4",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067052650",
            "telephone_number": "203-601-6423",
            "fax_number": "203-575-8399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 REIDVILLE DRIVE, SUITE A4",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067052650",
            "telephone_number": "203-601-6423",
            "fax_number": "203-575-8399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISMILE ORTHODONTICS OF WATERBURY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-02",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A",
        "authorized_official_last_name": "GIANNOUTSOS",
        "authorized_official_first_name": "EFSTATHIOS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-518-9128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.