Healthcare Provider Details

I. General information

NPI: 1740116359
Provider Name (Legal Business Name): BRISTOL DENTAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 EAST RD
BRISTOL CT
06010-6845
US

IV. Provider business mailing address

670 EAST RD
BRISTOL CT
06010-6845
US

V. Phone/Fax

Practice location:
  • Phone: 860-836-8679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARKOS RAPTIS
Title or Position: OWNER
Credential: DMD
Phone: 617-953-3780