| NPI | 1295374296 |
|---|---|
| Doing Business As | THE SMILE STUDIO AT BUSHNELL PARK |
| Entity Type | Organization |
| Authorized Contact | BRYAN WILSON Owner 860-728-5264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2019-12-23 |