MEDICARE: LITCHFIELD CENTER 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1164159430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITCHFIELD CENTER DENTAL PC

Provider Business Mailing Address
First Line	:	PO BOX 60
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-0060
Country	:	US
Telephone Number	:	860-567-5502
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WEST ST
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3501
Country	:	US
Telephone Number	:	860-567-5502
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	WONJOON CHOI
Credential	:
Telephone Number	:	860-567-5502

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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Directions to “LITCHFIELD CENTER DENTAL PC ” Practice Location

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