Healthcare Provider Details

I. General information

NPI: 1770675951
Provider Name (Legal Business Name): EDWARD JUOZOKAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ELM ST SUITE 209
ENFIELD CT
06082-3712
US

IV. Provider business mailing address

115 ELM ST SUITE 209
ENFIELD CT
06082-3712
US

V. Phone/Fax

Practice location:
  • Phone: 860-741-2277
  • Fax: 860-253-0170
Mailing address:
  • Phone: 860-741-2277
  • Fax: 860-253-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number005401
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: