Healthcare Provider Details

I. General information

NPI: 1306951199
Provider Name (Legal Business Name): PAUL J ESPOSITO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OLD NEW MILFORD RD SUITE 1G
BROOKFIELD CT
06804-2430
US

IV. Provider business mailing address

60 OLD NEW MILFORD RD SUITE 1G
BROOKFIELD CT
06804-2430
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-3839
  • Fax: 203-775-6181
Mailing address:
  • Phone: 203-775-3839
  • Fax: 203-775-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4769
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: