Healthcare Provider Details

I. General information

NPI: 1831219021
Provider Name (Legal Business Name): ADVANCED DENTAL OF NEW ENGLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WEBSTER SQUARE RD
BERLIN CT
06037-2326
US

IV. Provider business mailing address

39 WEBSTER SQUARE RD
BERLIN CT
06037-2326
US

V. Phone/Fax

Practice location:
  • Phone: 860-828-3933
  • Fax: 860-828-1610
Mailing address:
  • Phone: 860-828-3933
  • Fax: 860-828-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberCT6968
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL MAROON
Title or Position: ONWER/MANAGING MEMBER
Credential: DMD
Phone: 860-828-3933