Healthcare Provider Details

I. General information

NPI: 1760880355
Provider Name (Legal Business Name): NAMITA KHANDELWAL BDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-2656
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-1710
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3710
  • Fax:
Mailing address:
  • Phone: 860-679-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number14633
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: