Healthcare Provider Details

I. General information

NPI: 1376704171
Provider Name (Legal Business Name): DAVID AARON FENTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

135 BRITTANY FARMS RD D
NEW BRITAIN CT
06053-1127
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2207
  • Fax: 860-679-1899
Mailing address:
  • Phone: 734-678-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number009812
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: