Healthcare Provider Details

I. General information

NPI: 1548473523
Provider Name (Legal Business Name): EASWAR NATARAJAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE UNIVERSITY DENTISTS
FARMINGTON CT
06030
US

IV. Provider business mailing address

263 FARMINGTON AVENUE UNIVERSITY DENTISTS
FARMINGTON CT
06030-2820
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3170
  • Fax: 860-679-8162
Mailing address:
  • Phone: 860-679-3170
  • Fax: 860-679-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number009509
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009509
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: