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NPI Code Detail

MEDICARE: CROMWELL FAMILY DENTAL, PC

MEDICARE: CROMWELL FAMILY DENTAL, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry8633CT

General Provider Information

NPI Number : 1043357825
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROMWELL FAMILY DENTAL, PC
Provider Business Mailing Address
First Line : 136 BERLIN RD
Second Line :
City : CROMWELL
State : CT
Zip : 06416-2627
Country : US
Telephone Number : 860-635-6445
Fax Number : 860-635-8595
Provider Business Practice Location Address
First Line : 136 BERLIN RD
Second Line :
City : CROMWELL
State : CT
Zip : 06416-2627
Country : US
Telephone Number : 860-635-6445
Fax Number : 860-635-8595
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT ALAN BREAULT
Credential : D.M.D.
Telephone Number : 860-635-6445
Provider Enumeration Date : 01/31/2007
Last Update Date : 08/22/2020

Similar Medicare Providers

1477555787 — DR. RAYMOND L D'AMATO M.D.
Practice Location Address:
136 BERLIN RD , SUITE 102
CROMWELL, CT
06416-2627
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1508800806 — MARTA J KROO MD
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136 BERLIN RD
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1578609145 — DR. JEFFREY JOSEPH SCULL DDS
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1437296423 — DR. ROBERT ALAN BREAULT D.M.D.
Practice Location Address:
136 BERLIN RD
CROMWELL, CT
06416-2627
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Practice Fax: 860-635-8595
1689819112 — MRS. PHOEBE C.M. ROMERO PA-C
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06416-2627
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1972872554 — ANITA VELTA GRINEVICS RD
Practice Location Address:
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Directions to “CROMWELL FAMILY DENTAL, PC ” Practice Location

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