Healthcare Provider Details

I. General information

NPI: 1124333265
Provider Name (Legal Business Name): SATYASHANKARA ADITYA TADINADA D.D.S, M.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 09/28/2022
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-3571
US

IV. Provider business mailing address

263 FARMINGTON AVE UCONN SCHOOL OF DENTAL MEDICINE
FARMINGTON CT
06032-1956
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3415
  • Fax: 860-679-7507
Mailing address:
  • Phone: 860-679-2207
  • Fax: 860-679-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number010519
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: