Organization
THE SMILE STUDIO AT BUSHNELL PARK
Active
Other names
The Smile Studio at Bushnell Park
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN WILSON DDS (OWNER)
(860) 728-5264
Entity
Organization
Contact information
Practice address
1 GOLD ST STE Q, HARTFORD, CT 06103-2914
(860) 728-5264
Mailing address
1 GOLD ST STE Q, HARTFORD, CT 06103-2914
(860) 728-5264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093881534
NPI
CT
Enumeration date
12/23/2019
Last updated
12/23/2019
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