Healthcare Provider Details

I. General information

NPI: 1982729158
Provider Name (Legal Business Name): THE DENTAL TEAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 FEDERAL ROAD
BROOKFIELD CT
06804
US

IV. Provider business mailing address

109 FEDERAL ROAD
BROOKFIELD CT
06804
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-1771
  • Fax: 203-775-1967
Mailing address:
  • Phone: 203-775-1771
  • Fax: 203-775-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN G REISS
Title or Position: OWNER/ PRESIDENT
Credential: D.D.S.
Phone: 203-775-1771