Healthcare Provider Details

I. General information

NPI: 1033536313
Provider Name (Legal Business Name): DARIEN DENTAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POST RD FL 3
DARIEN CT
06820-4622
US

IV. Provider business mailing address

800 POST RD FL 3
DARIEN CT
06820-4622
US

V. Phone/Fax

Practice location:
  • Phone: 203-656-8079
  • Fax:
Mailing address:
  • Phone: 203-656-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9703
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9703
License Number StateCT

VIII. Authorized Official

Name: DR. JOHN J PRESTI
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 203-656-8079