Healthcare Provider Details

I. General information

NPI: 1255431466
Provider Name (Legal Business Name): KUHLBERG ORTHODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/23/2015
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

70 W AVON RD
AVON CT
06001-3517
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANDREW J KUHLBERG
Title or Position: OWNER
Credential: DMD
Phone: 860-673-5081