Healthcare Provider Details

I. General information

NPI: 1366319808
Provider Name (Legal Business Name): VOLMIR ANTONIO FAEDO JR. ORTHODONTICS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/24/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 DOWLING WAY
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

2 PARK PL
HARTFORD CT
06106-5007
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2000
  • Fax:
Mailing address:
  • Phone: 860-816-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number000000
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: