Healthcare Provider Details

I. General information

NPI: 1013260942
Provider Name (Legal Business Name): SUMIT YADAV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE L 7063
FARMINGTON CT
06030-1000
US

IV. Provider business mailing address

263 FARMINGTON AVE MC3905
FARMINGTON CT
06030-3905
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2664
  • Fax: 860-679-1920
Mailing address:
  • Phone: 860-679-2207
  • Fax: 860-679-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number010367
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: