Healthcare Provider Details

I. General information

NPI: 1649813783
Provider Name (Legal Business Name): PEOPLESDENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W AVON RD STE 101
AVON CT
06001-3677
US

IV. Provider business mailing address

20 W AVON RD STE 101
AVON CT
06001-3677
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-0451
  • Fax:
Mailing address:
  • Phone: 860-874-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LEAH ANN MAYLOTT
Title or Position: CREDENTIALING ADMINISTRATOR
Credential:
Phone: 860-874-8198