Healthcare Provider Details

I. General information

NPI: 1447463526
Provider Name (Legal Business Name): AVON DENTAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W AVON RD
AVON CT
06001-3677
US

IV. Provider business mailing address

20 W AVON RD
AVON CT
06001-3677
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1223G0001X
License Number StateCT

VIII. Authorized Official

Name: DANIEL BRIAN GEELAN
Title or Position: PARTNER
Credential: D.M.D.
Phone: 860-673-0451