Healthcare Provider Details

I. General information

NPI: 1235239419
Provider Name (Legal Business Name): ANDREW J KUHLBERG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W AVON RD
AVON CT
06001-3517
US

IV. Provider business mailing address

12 CHRISTMAS TREE HL
CANTON CT
06019-2125
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-5081
  • Fax:
Mailing address:
  • Phone: 860-693-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number007824
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: