Healthcare Provider Details

I. General information

NPI: 1447202593
Provider Name (Legal Business Name): ROBERT A ROSSETTI DMD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 PALAMBA DRIVE
ENFIELD CT
06082
US

IV. Provider business mailing address

76 PALAMBA DRIVE
ENFIELD CT
06082
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-9298
  • Fax: 860-253-9689
Mailing address:
  • Phone: 860-253-9298
  • Fax: 860-253-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number007472
License Number StateCT

VIII. Authorized Official

Name: DR. ROBERT A ROSSETTI
Title or Position: PRESIDENT
Credential: DMD MD PC
Phone: 860-253-9298