Healthcare Provider Details

I. General information

NPI: 1629268982
Provider Name (Legal Business Name): ROUND AND HERRICK FAMILY DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE. SUITE 105
GLASTONBURY CT
06033
US

IV. Provider business mailing address

622 HEBRON AVE. SUITE 105
GLASTONBURY CT
06033
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-1809
  • Fax: 860-633-1809
Mailing address:
  • Phone: 860-633-1809
  • Fax: 860-633-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ROUND
Title or Position: VP
Credential: DMD
Phone: 860-633-1809