Healthcare Provider Details

I. General information

NPI: 1083365530
Provider Name (Legal Business Name): RAJ ENTERPRISES OF CROMWELL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SHUNPIKE RD STE 7
CROMWELL CT
06416-2454
US

IV. Provider business mailing address

5 STONE BROOK XING
ROCKY HILL CT
06067-2933
US

V. Phone/Fax

Practice location:
  • Phone: 860-955-0995
  • Fax:
Mailing address:
  • Phone: 860-955-0995
  • Fax:

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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUPESH PANDEY
Title or Position: PRESIDENT
Credential:
Phone: 860-955-0995