Healthcare Provider Details

I. General information

NPI: 1356551865
Provider Name (Legal Business Name): DENTAL SOLUTIONS OF GLASTONBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 NEW LONDON TPKE SUITE 211
GLASTONBURY CT
06033-2246
US

IV. Provider business mailing address

127 HAYSTACK ROAD
MANCHESTER CT
06040
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-0486
  • Fax: 860-659-2126
Mailing address:
  • Phone: 860-646-1344
  • Fax: 860-659-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8556
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4862
License Number StateCT

VIII. Authorized Official

Name: ROBERT J HENIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 860-633-0486