Healthcare Provider Details

I. General information

NPI: 1528241429
Provider Name (Legal Business Name): CINDY GROSSO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY DAWSON

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

IV. Provider business mailing address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108-3013
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax: 860-528-5180
Mailing address:
  • Phone: 860-528-1359
  • Fax: 860-528-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number004125
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: